Modulating vascular stresses through homeostatic remodelling: a multi-patient analysis of atherosclerotic carotid biomechanics

The biomechanical behaviour of vascular tissues is influenced by the presence of residual stresses, yet their role in vascular adaptation to pathological conditions remains largely unexplored. These residual stresses may arise within the vessel wall as a result of growth and remodelling (G&R) processes governed by the principles of tensional homeostasis. This study extends our previous work by refining a computational workflow that integrates homeostasis-driven G&R into patient-specific carotid geometries. Key advancements include adopting a total Lagrangian framework to handle complex geometries, introducing novel post-processing metrics for improved comparisons and conducting statistical analyses to assess G&R's impact on biomechanical evaluations of atherosclerotic vessels. These improvements enabled the analysis of a cohort of 18 cases, incorporating patient-specific geometries and pathological tissue distributions reconstructed from clinical imaging data. Results suggest that G&R generally reduces peak stress, though its effectiveness depends on plaque morphology and tissue composition. High calcification leads to localized stress concentrations, limiting remodelling, whereas matrix-rich regions promote stress homogenization. At the cohort level, findings underscore the need for patient-specific analyses in plaque risk evaluation, reinforcing the importance of personalized biomechanical modelling in assessing atherosclerotic disease and guiding clinical decision-making.