Rupture Risk Assessment of Cervical Spinal Manipulations on Carotid Atherosclerotic Plaque by a 3D Fluid-Structure Interaction Model.

Method: The FSI model, based on MRI data of an atherosclerosis patient, was used to simulate the deformations of the plaque and lumen during the process of two kinds of typical cSMT (the high-speed, low-amplitude spinal manipulation and the cervical rotatory manipulation). The biomechanical parameters were recorded, such as the highest wall shear stress (WSS), the maximum plaque wall stress (PWS), the wall tensile stress (Von mises stress, VWTS), and the strain.

Result: The max_WSS was 33.77 kPa in the most extensive deformation. The highest WSS region on the plaque surface was also the highest PWS region. The max_PWS in a 12% stretch was 55.11 kPa, which was lower than the rupture threshold. The max_VWTS of the cap in 12% stretch which approached the fracture stress level was 116.75 kPa. Moreover, the vessel's max_VWTS values in 10% and 12% stretch were 554.21 and 855.19 kPa. They were higher than the fracture threshold, which might cause media fracture. Meanwhile, the 7% stretched strain was 0.29, closed to the smallest experimental green strains at rupture.

Conclusion: The carotid arteries' higher stretch generated the higher stress level of the plaque. Cervical rotatory manipulation might cause plaque at a high risk of rupture in deformation after 12% stretch and more. Lower deformation of the plaque and artery caused by the high-speed, low-amplitude spinal manipulation might be safer.