Summary and prospect
In summary, WSS plays an important role in the occurrence and development of atherosclerosis. The complex blood flow in arteries forms rich WSS vectorial features (
99), including the newly proposed WSS topological skeleton to identify and classify the WSS fixed points and manifolds in complex vascular geometries. CFD modeling represents one of the attempts to simulate these complex hemodynamic conditions to investigate the impact of WSS on atherosclerosis. Low WSS is the factor of early plaque formation, and high WSS promotes the transformation of plaque to high-risk phenotype, that is, low WSS induces the occurrence and development of plaque, while high WSS is related to plaque instability. WSS acts as a link between blood flow dynamics and the biology of various cardiovascular diseases (
99). Low WSS and high WSS are involved in the loss of physiological flow alignment of endothelial cells, the increase of low-density lipoprotein accumulation, the proliferation and apoptosis of smooth muscle cells, the high expression of inflammatory factors and adhesion molecules, and the abnormal activation of platelets, which promote the occurrence and development of atherosclerosis. Overall, WSS can potentially provide insight into the onset of initial lesions and progression to more advanced lesions, playing a crucial role in regulating hemodynamically directed atherosclerotic vascular disease. Understanding the detailed mechanisms by which WSS regulates hemodynamically directed vascular disease will help us elucidate the pathogenesis of atherosclerosis and develop potential therapeutic strategies for atherosclerosis, as shown in
Figure 2. The current clinical detection methods can assist in the secondary prevention after the occurrence of lesions, while more prognostic research is needed in the primary prevention process. The regulatory role of WSS in atherogenesis remains to be investigated. Combining clinical imaging techniques with CFD allows for detailed examination of local morphological and biomechanical characteristics of atherosclerotic lesions to identify more effective WSS-based hemodynamic indicators, so as to close the gap of knowledge currently limiting the use of WSS as a bio-marker for diagnostic and prognostic purposes. Ultimately, WSS will be used as a biomarker of vascular status and atherosclerotic lesion burden to identify early plaque and monitor plaque stability, and provide a rationale for a paradigm shift towards pre-emptive treatment strategies.