Biomech Model Mechanobiol. 2026 Jan 13;25(1):20. doi: 10.1007/s10237-026-02041-1.
ABSTRACT
Accurately identifying coronary vulnerable plaque that would cause major adverse clinical events based on morphological characteristics remains a major clinical challenge. Plaque biomechanics are closely associated with plaque rupture and could assist in rupture risk stratification to identify high-risk coronary plaques for potential intervention. In vivo optical coherence tomography images of 40 coronary plaques from 40 patients with coronary artery disease were acquired and categorized into three groups according to their morphological characteristics: stable, vulnerable, and ruptured plaques. Finite element analysis was performed to obtain the peak stress value over the fibrous cap and shoulder region denoted as critical plaque wall stress (CPWS). A rupture risk stratification scheme was proposed based on the CPWS value to classify three plaque groups from biomechanical perspective, and its agreement rate with morphological classification was calculated. Ruptured and vulnerable plaques exhibited significant higher CPWS values than stable ones while no significant difference was found between ruptured and vulnerable plaques. The biomechanical risk stratification scheme was formed using 150 kPa and 230 kPa as threshold values for CPWS to classify three types of plaques, and its agreement rates with morphological classification were 17/20, 5/10, and 7/10 for stable, vulnerable, and ruptured plaques, respectively. This biomechanical scheme holds the potential to accurately stratify the rupture risk of coronary plaques as demonstrated by reasonable concordance with morphological classification. Discrepancy between two classifications highlights the unique value of biomechanical scheme, when integrated with morphological classification, in preventing unnecessary interventions and detecting rupture-prone plaques.
PMID:41530323 | DOI:10.1007/s10237-026-02041-1