Vulnerable coronary atherosclerotic plaque rupture is a recognized major cause of acute coronary syndrome. Such vulnerable plaques can be detected clinically by various techniques, including intravascular ultrasound (IVUS) and optical coherence tomography. Detecting lesions vulnerable to rupture is a major issue, as it could lead to the development of specific treatment strategies for the prevention of acute thrombotic events. Clinical and biomechanical studies performed recently by our group have originally identified new morphological factors as the key predictors of vulnerability to rupture. Moreover, it is now recognized that prediction of the vulnerable coronary plaque rupture requires not only an accurate quantification of fibrous cap thickness and necrotic core morphology but also a precise knowledge of the mechanical properties of plaque components (IVUS Modulography of Atheroma Plaque). We demonstrated why, in clinical practice, biomechanical plaque instability is not a consequence of Cap_tick alone, but rather of a subtle combination of Cap_thick, Core_thick and Remod_index. Moreover, Residual Stress/Strain (RS/S) present in a vulnerable coronary plaque dramatically influences the spatial stress distribution and spotlights some new sites of stress concentration. RS/S could play a major role in the biomechanical stability of vulnerable coronary plaque and in the growth process of the lipid core. Additionally, we showed that plaque rupture is to be viewed as a consequence not of external pressure alone but rather of a subtle combination of external loading and intraplaque RS/S.

Recent publications of our group in this field