Necrotic Core in Advanced Atherosclerotic Plaques in Human Coronaries Is Exposed to Elavated Shear Stress

In early atherosclerosis, plaques localize in low shear stress regions. During plaque development, the lumen of the artery remains patent due to vascular remodeling and unfavorable low shear stress conditions can persist. Consequently, a continuous influx of lipids can be anticipated in these regions, possibly leading to the development vulnerable plaques. If the plaque exceeds a certain size, vascular remodeling will not be able to maintain the lumen dimensions and the plaque will cause lumen narrowing. This is generally accompanied by shear stress increase in certain regions of the plaque. Evidence is accumulating that increased levels of shear stress influences plaque composition in such a way that it might induce plaque destabilization and ulcer formation.