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Atherosclerosis and Hemodynamics

The effect of local hemodynamic factors on localization of plaque has been studied mainly in the carotid bifurcation, initially in glass models, but more recently it was validated with magnetic resonance angiographic (MRA) imaging and by computer modeling. 19,20 Intimal thickening develops largely in areas of low wall shear stress, in areas of flow separation, and areas with high particle residence time. The theory is that all of these factors facilitate particle (e.g., LDL) interaction with the arterial wall. Caro postulated that low wall shear stress results in slowed transport of circulating particles away from the wall, resulting in the increased intimal accumulation of lipids.

Oscillating shear stress, such as that which occurs in the carotid bulb with areas of transient flow reversal, has been implicated in early lesion formation.

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