Carotid plaque rupture depends on the various types of mechanical stresses. Our objective was to determine the multiaxial mechanical characteristics of atherosclerotic plaque and adjacent segment of the common carotid artery (CCA).

A novel non-invasive echotracking system was used to measure intimamedia thickness, diameter, pulsatile strain, and distensibility at 128 sites on a 4 cm long CCA segment. The study included 62 patients with recent cerebrovascular ischemic event and either a plaque on the far wall of CCA (n = 25) or no plaque (n = 37). The mechanical characteristics of the carotid segment devoid of plaque did not differ between the two groups. Among patients with plaque, 16 had a larger radial strain at the level of plaque than at the level of adjacent CCA (pattern A: outward bending strain). The 8 patients who had an opposite pattern (inward bending strain) were more often dyslipidemic (100% vs 56% P = 0.03) and type 2 diabetic (63% vs 12%, P = 0.04) than pattern A patients. Strain gradient significantly decreased in parallel with the presence of dyslipidemia and/or type 2 diabetes. Longitudinal gradients of distensibility and Young’s elastic modulus were consistent with strain gradients.

In conclusion, type 2 diabetes and dyslipidemia were associated with a stiffer carotid at the level of the plaque than in adjacent CCA, leading to an inward bending stress. The analysis of plaque mechanics along the longitudinal axis may afford useful information, since repetitive bending strain of an atherosclerotic plaque may fatigue the wall material and result in plaque rupture.