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(Stroke. 2007;38:2379.)
© 2007 American Heart Association, Inc.

Case Report

Plaque Rupture in the Carotid Artery Is Localized at the High Shear Stress Region

A Case Report

Harald C. Groen, MSc; Frank J.H. Gijsen, PhD; Aad van der Lugt, MD, PhD; Marina S. Ferguson, MT; Thomas S. Hatsukami, MD; Anton F.W. van der Steen, PhD; Chun Yuan, PhD Jolanda J. Wentzel, PhD

From Biomedical Engineering (H.C.G., F.J.H.G., A.F.W.v.d.S., J.J.W.), Erasmus MC, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (H.C.G., A.F.W.v.d.S., J.J.W.), Utrecht, The Netherlands; Radiology (H.C.G., A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Radiology (M.S.F, C.Y.) and Surgery (T.S.H.), University of Washington, Seattle, Wash.

Correspondence to Jolanda Wentzel, Biomedical Engineering, Biomechanics Laboratory, Ee2322, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail j.wentzel{at}erasmusmc.nl

Background and Purpose— Cerebrovascular events are related to atherosclerotic disease in the carotid arteries and are frequently caused by rupture of a vulnerable plaque. These ruptures are often observed at the upstream region of the plaque, where the wall shear stress (WSS) is considered to be highest. High WSS is known for its influence on many processes affecting tissue regression. Until now, there have been no serial studies showing the relationship between plaque rupture and WSS.

Summary of Case— We investigated a serial MRI data set of a 67-year-old woman with a plaque in the carotid artery at baseline and an ulcer at 10-month follow up. The lumen, plaque components (lipid/necrotic core, intraplaque hemorrhage), and ulcer were segmented and the lumen contours at baseline were used for WSS calculation. Correlation of the change in plaque composition with the WSS at baseline showed that the ulcer was generated exclusively at the high WSS location.

Conclusions— In this serial MRI study, we found plaque ulceration at the high WSS location of a protruding plaque in the carotid artery. Our data suggest that high WSS influences plaque vulnerability and therefore may become a potential parameter for predicting future events.

Key Words: carotid artery • MRI • shear stress • ulceration

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