Numerical investigation of atherosclerotic plaque rupture using optical coherence tomography imaging and XFEM

Myocardial infarction contributes to most fatalities in which atherosclerotic plaque disruption is the underlying pathology. From the mechanics view point, the pulsatile blood flow in the arteries resembles a fatigue environment and generates stresses that affect the rupture of the atherosclerotic plaque. In this context, patient-specific optical coherence tomography (OCT) was used to develop the fatigue crack growth behavior. The impact of location specific morphological features and their relative effect on plaque life were discussed. EXtended Finite Element Method (XFEM) and Paris' Law were employed to investigate the fatigue crack growth. Twelve 2D slices from six patients were reconstructed for studying the fatigue crack growth behavior. Our results indicate that plaque life decreases with an increase in pulse pressure and 53.5% of the total cracks initiated at various locations on the lumen lead to rupture. 73.7% of the rupture locations did not have calcifications. Correlation between the location specific morphology and the rupture indicates that for a 1 mm increase in the fibrous cap thickness there is a large decrease in the odds of rupture [0.163 (0.073; 0.363)], p-value < 0.0001; and for a 1 mm(2) increase of the calcification area, there is a decrease in the odds of rupture by 0.719 (0.619; 0.835), p-value < 0.0001. In conclusion, the XFEM technique can be used to study the fatigue behavior of the atherosclerotic plaque that depends on the combined effects of plaque constituents and their morphology. It may help to better assess plaque vulnerability and make more accurate predictions for plaque rupture.