Calcifications in atherosclerotic plaques and impact on plaque biomechanics

Abstract

The catastrophic mechanical rupture of an atherosclerotic plaque is the underlying cause of the majority \nof cardiovascular events. The infestation of vascular calcification in the plaques creates a mechanically \ncomplex tissue composite. Local stress concentrations and plaque tissue strength properties are the governing parameters required to predict plaque ruptures. Advanced imaging techniques have permitted \ninsight into fundamental mechanisms driving the initiating inflammatory-driven vascular calcification \nof the diseased intima at the (sub-) micron scale and up to the macroscale. Clinical studies have potentiated the biomechanical relevance of calcification through the derivation of links between local plaque \nrupture and specific macrocalcification geometrical features. The clinical implications of the data presented in this review indicate that the combination of imaging, experimental testing, and computational \nmodelling efforts are crucial to predict the rupture risk for atherosclerotic plaques. Specialised experimental tests and modelling efforts have further enhanced the knowledge base for calcified plaque tissue \nmechanical properties. However, capturing the temporal instability and rupture causality in the plaque \nfibrous caps remains elusive. Is it necessary to move our experimental efforts down in scale towards \nthe fundamental (sub-) micron scales in order to interpret the true mechanical behaviour of calcified plaque tissue interactions that is presented on a macroscale in the clinic and to further optimally assess calcified plaques in the context of biomechanical modelling