Cerebrovascular events are related to atherosclerotic disease in the carotid arteries and they are often caused by rupture of an atherosclerotic plaque. Rupture-prone, or vulnerable, plaques are characterized by their specific morphology and composition: a large lipid pool covered by a thin fibrous cap infiltrated by macrophages and expansive remodeling. The strength of the cap of a vulnerable plaque is determined by the material properties of the cap and its thickness. Plaque ruptures are often observed at the upstream region of the plaque [1], were the wall shear stress (WSS) is considered to be highest. High WSS is known for its influence on many processes affecting, among others, tissue regression [2]. Therefore, high shear stress induced cap regression might contribute to cap thinning, thus enhancing plaque vulnerability, and eventually leading to cap rupture [3,4]. Here we present the first results of a new approach to study the relationship between WSS and the location of ulcerations in severely stenotic carotid bifurcations by using computational fluid dynamics and computed tomography.

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