BIOCCORA · Full biomechanical characterization of the coronary atherosclerotic plaque: biomechanics meets imaging

Myocardial infarction is responsible for nearly 40% of the mortality in the western world and is mainly triggered by rupture of vulnerable atherosclerotic plaques in the coronary arteries. Biomechanical parameters play a major role in the generation and rupture of vulnerable plaques. I was the first to show the relationship between shear stress – one of the biomechanical parameters - and plaque formation in human coronary arteries in vivo. This accomplishment was achieved by the development of a new 3D reconstruction technique for (human) coronary arteries in vivo. This reconstruction technique allowed assessment of shear stress by computational fluid dynamics and thereby opened new avenues for serial studies on the role of biomechanical parameters in cardiovascular disease. However, these reconstructions lack information on the vessel wall composition, which is essential for stress computations in the vessel wall. Recent developments in intravascular image technologies allow visualization of one or more of the different plaque components. Therefore, advances in image fusion are required to merge the different plaque components into one single 3D vulnerable plaque reconstruction. I will go beyond the state-of-the art in image based modeling by developing novel technology to 3D reconstruct coronary lumen and vessel wall, including plaque composition and assess biomechanical tissue properties allowing for full biomechanical characterization (shear stress and wall stress) of the coronary plaque. The developed technology will be applied to study 1) vulnerable plaque progression, destabilization and rupture, to improve identification of risk on myocardial infarction and 2) predicting treatment outcome of stent implantation by simulating stent deployment, thereby opening a whole new direction in cardiovascular research.