Effect of calcification on the mechanical stability of plaque based on a three-dimensional carotid bifurcation model

Modelling atherosclerotic plaque based on structural analysis confirms the rationale for plaque mechanical examination and the feasibility of our simulation model. Meaningful validation of predictions from modelled atherosclerotic plaque model typically requires examination of bona fide atherosclerotic lesions. To analyze a more accurate plaque rupture, fluid-structure interaction is applied to three-dimensional blood-vessel carotid bifurcation modelling. A patient-specific pressure variation is applied onto the plaque to influence its vulnerability.Modelling of the human atherosclerotic artery with varying degrees of lipid core elasticity, fibrous cap thickness and calcification gap, which is defined as the distance between the fibrous cap and calcification agglomerate, form the basis of our rupture analysis. Finite element analysis shows that the calcification gap should be conservatively smaller than its threshold to maintain plaque stability. The results add new mechanistic insights and methodologically sound data to investigate plaque rupture mechanics.Structural analysis using a three-dimensional calcified model represents a more realistic simulation of late-stage atherosclerotic plaque. We also demonstrate that increases of calcium content that is coupled with a decrease in lipid core volume can stabilize plaque structurally.Atherosclerosis constitutes a high number of deaths related to cardiovascular diseases in developed countries. It is a chronic systemic disease, frequently leading to vascular morbidity and premature mortality. Although atherosclerosis is systemic, plaque rupture is local and leads to acute cardiac syndromes such as ischemia and myocardial infarction or cerebrovascular events. Plaque material and structural characteristics are important factors in the natural progression of the disease and may have important clinical predictive value.Extensively calcified lesions most likely represent atherosclerosis at later stages of remodelling and may