Hemodynamic Shear Stress and Its Role in Atherosclerosis
 Adel M. Malek, MD, PhD; Seth L. Alper, MD, PhD; Seigo Izumo, MD


( JAMA 1999; 282:2035 - 2042 )

Figure 2. Localization of Atherosclerosis Lesions

A, Schematic illustration of the focal nature of atherosclerosis and its tendency to involve the outer walls of vascular bifurcations such as the carotid, coronary, renal, and iliac artery flow dividers. B, Left lateral cervical carotid arteriogram in a 75-year-old man who experienced an embolic stroke in the left temporal lobe. Focal narrowing is seen at the outer walls of the common carotid artery bifurcation in both the internal carotid artery (arrowhead) and the external carotid artery (arrowhead). C, Velocity map of the carotid bifurcation at end-systole using computational fluid dynamic modeling illustrates the lower velocities seen at the outer lateral edges (blue).38 The computed wall shear stress (bottom) shows the focal low shear magnitude at the outer walls that correspond exactly to the atherosclerosis-prone areas of the carotid bifurcation (compare with B) and is in contrast with the less susceptible inner regions of the bifurcation where flow velocity and, consequently, hemodynamic shear stress at the vessel wall is higher (yellow and green). (Courtesy of Drs David Saloner and Liang-Der Jou, University of California, Berkeley).

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