Summary
Atherosclerotic plaques are found at distinct locations in the arterial system, despite
the exposure to systemic risk factors of the entire vascular tree. From the study
of arterial bifurcation regions, emerges ample evidence that haemodynamics are involved
in the local onset and progression of the atherosclerotic disease. This observed co-localisation
of disturbed flow regions and lesion prevalence at geometrically predisposed districts
such as arterial bifurcations has led to the formulation of a ‘haemodynamic hypothesis’,
that in this review is grounded to the most current research concerning localising
factors of vascular disease. In particular, this review focuses on carotid and coronary
bifurcations because of their primary relevance to stroke and heart attack. We highlight
reported relationships between atherosclerotic plaque location, progression and composition,
and fluid forces at vessel’s wall, in particular shear stress and its ‘easier-tomeasure’
surrogates, i.e. vascular geometric attributes (because geometry shapes the flow)
and intravascular flow features (because they mediate disturbed shear stress), in
order to give more insight in plaque initiation and destabilisation. Analogous to
Virchow’s triad for thrombosis, atherosclerosis must be thought of as subject to a
triad of, and especially interactions among, haemodynamic forces, systemic risk factors,
and the biological response of the wall.
Keywords
Atherosclerosis - biomechanics - shear stress - arterial bifurcation - haemodynamics
