@article{3175788,
    title = "Association of global and local low endothelial shear stress with
high-risk plaque using intracoronary 3D optical coherence tomography:
Introduction of `shear stress score'",
    author = "Chatzizisis, Yiannis S. and Toutouzas, Konstantinos and Giannopoulos, and Andreas A. and Riga, Maria and Antoniadis, Antonios P. and Fujinom, and Yusuke and Mitsouras, Dimitrios and Koutkias, Vassilis G. and and Cheimariotis, Grigorios and Doulaverakis, Charalampos and and Tsampoulatidis, Ioannis and Chouvarda, Ioanna and Kompatsiaris, Ioannis and and Nakamura, Sunao and Rybicki, Frank J. and Maglaveras, Nicos and and Tousoulis, Dimitris and Giannoglou, George D.",
    journal = "European Heart Journal - Cardiovascular Imaging",
    year = "2017",
    volume = "18",
    number = "8",
    pages = "888-897",
    publisher = "Oxford University Press",
    issn = "2047-2404, 2047-2412",
    doi = "10.1093/ehjci/jew134",
    keywords = "coronary artery disease; optical coherence tomography; high-risk plaque;
endothelial shear stress; shear stress score; vascular remodelling;
clinical events",
    abstract = "Aims The association of low endothelial shear stress (ESS) with
high-risk plaque (HRP) has not been thoroughly investigated in humans.
We investigated the local ESS and lumen remodelling patterns in HRPs
using optical coherence tomography (OCT), developed the shear stress
score, and explored its association with the prevalence of HRPs and
clinical outcomes.
Methods and results A total of 35 coronary arteries from 30 patients
with stable angina or acute coronary syndrome (ACS) were reconstructed
with three dimensional (3D) OCT. ESS was calculated using computational
fluid dynamics and classified into low, moderate, and high in 3-mm-long
subsegments. In each subsegment, (i) fibroatheromas (FAs) were
classified into HRPs and non-HRPs based on fibrous cap (FC) thickness
and lipid pool size, and (ii) lumen remodelling was classified into
constrictive, compensatory, and expansive. In each artery the shear
stress score was calculated as metric of the extent and severity of low
ESS. FAs in low ESS subsegments had thinner FC compared with high ESS
(89 +/- 84 vs. 138 +/- 83 mu m, P, 0.05). Low ESS subsegments
predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P, 0.05)
and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P,
0.05). Compensatory and expansive lumen remodelling were the predominant
responses within subsegments with low ESS and HRPs. In non-stenotic FAs,
low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P, 0.05).
Arteries with increased shear stress score had increased frequency of
HRPs and were associated with ACS vs. stable angina.
Conclusion Local low ESS and expansive lumen remodelling are associated
with HRP. Arteries with increased shear stress score have increased
frequency of HRPs and propensity to present with ACS."
}