Prediction of coronary artery disease progression in human from numerically determined endothelial shear stress

Using a technique in which intravascular ultrasound images are fused with two planes of angiography, blood flow is measured, and the Navier Stokes equations are solved in 3 dimensions, we have studied the remodeling characteristic of 55 human coronary arteries and the relationship of endothelial shear stress (ESS) to remodeling and plaque progression in 13 human arteries. Results indicate that the remodeling characteristics of 87% of coronaries with minimal luminal narrowing are constant along the length of the artery: 60% percent demonstrate compensatory remodeling; 19% exhibit under-remodeling (consistent with stable CAD) and 21% exhibit excessive remodeling (consistent with unstable syndromes). Serial studies show that plaque progresses almost exclusively in regions of low ESS (<12 dyne/cm²). This suggests a new paradigm that focuses on segments with low ESS, treating those with excessive remodeling as being at risk for unstable syndromes and those with inadequate remodeling as being at risk for stable CAD