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In addition to plaque rupture, biomechanics also contributes toward the progression of thin-cap fibroatheroma through a multitude of reported mechanobiological mechanisms. We thus propose a new mechanism whereby both shear stress and wall stress interact to create thin-cap fibroatheromas. Specifically, when regions of certain blood flow and wall mechanical stimuli coincide, they synergistically create inflammation within the cellular environment that can lead to thin-cap fibroatheroma rupture. A consequence of this postulate is that local shear stress is not sufficient to cause rupture, but it must coincide with regions of local tissue stiffening and stress concentrations that can occur during plaque progression. Because such changes to the wall mechanics occur over a micrometer scale, high spatial resolution imaging techniques will be necessary to evaluate this hypothesis and ultimately predict plaque rupture in a clinical environment.<\/jats:p>","DOI":"10.1161\/atvbaha.114.303426","type":"journal-article","created":{"date-parts":[[2014,7,25]],"date-time":"2014-07-25T07:14:41Z","timestamp":1406272481000},"page":"2224-2231","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Thin-Cap Fibroatheroma Rupture Is Associated With a Fine Interplay of Shear and Wall Stress"],"prefix":"10.1161","volume":"34","author":[{"given":"Ryan M.","family":"Pedrigi","sequence":"first","affiliation":[{"name":"From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranil","family":"de Silva","sequence":"additional","affiliation":[{"name":"From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra M.","family":"Bovens","sequence":"additional","affiliation":[{"name":"From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram V.","family":"Mehta","sequence":"additional","affiliation":[{"name":"From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Petretto","sequence":"additional","affiliation":[{"name":"From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Krams","sequence":"additional","affiliation":[{"name":"From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0b013e31828124ad"},{"key":"e_1_3_4_3_2","first-page":"883","article-title":"Mechanisms of acute coronary syndromes.","volume":"369","author":"Libby P","year":"2013","unstructured":"Libby P. 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