Ney Carter Borges: Biomechanics of Plaque Erosion in ACS
Ney Carter Borges, Member Cardiologist of Global Physician Association at Cleveland Clinic Florida, shared a post on LinkedIn:
“Biomechanical Determinants of Plaque Erosion: Toward Precision Management of Acute Coronary Syndromes
Plaque erosion has emerged as a major mechanism of acute coronary syndrome (ACS), accounting for approximately 30–40% of STEMI and nearly 50% of NSTEMI cases. Unlike plaque rupture, erosion occurs over an intact fibrous cap, with endothelial denudation and platelet-rich thrombus formation rather than fibrous-cap disruption.
This state-of-the-art review highlights the pivotal role of biomechanics in plaque erosion.
Computational fluid dynamics (CFD) and finite element analysis (FEA) demonstrate that regions exposed to high endothelial shear stress (ESS), steep shear stress gradients (ESSG), and adverse plaque structural stress promote endothelial dysfunction, inflammatory activation, neutrophil extracellular trap (NET) formation, and thrombosis.
Integrating these biomechanical signatures with OCT imaging may identify erosion-prone plaques before clinical events occur.
From a cardiovascular perspective, these findings support a transition toward precision cardiology.
Selected patients with OCT-confirmed plaque erosion and limited residual stenosis may be treated successfully with intensive antithrombotic therapy without routine stent implantation, while future incorporation of artificial intelligence and real-time biomechanical analysis may improve individualized risk stratification and optimize intervention strategies.
Although promising, these approaches still require prospective clinical validation before routine implementation.”
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