Figure 4.

Concept of the influence of shear stress and wall stress on plaque rupture. Co-localization of peak wall stress and shear stress-induced cap thinning and cap strength will dictate location and timing of plaque rupture. (A) (Excessive) compensatory remodelling induces low shear stress stimulating local inflammation and thereby fibrous cap thinning and plaque weakening, influencing the cap strength, (B) high shear stress induces cap thinning and weakening. Wall stress inside the cap is related to blood pressure and the local cap geometry and thickness. If the local wall stress exceeds the cap strength (the wall stress threshold at which it ruptures), the cap will rupture.