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Cardiovascular disease caused by atherosclerosis is the first cause of mortality and disability around the world. To understand the pathophysiology of the atherosclerotic plaques and specially their hemodynamics, the changes with their evolution or with the therapeutic interventions are essential to develop effective diagnostic and therapeutic interventions to stop the cardiovascular pandemics. Ultrasound is a cheap, simple and accessible methodology that experienced in the last three decades an astounding development in terms of technology and diagnostic precision. In the field of doppler ultrasound, Power doppler and color doppler enabled a detailed evaluation of cardiac valves, arteries and veins that conducted to impressive diagnostic precision and to enable advances in therapeutic interventions. Recently a new doppler technology based on processing in blocks the ultrasound information and transduce it into a vector representation of the displacement of blood flow in the space, named VFLOW®, conducted to a new field of investigation of complex flow patterns, by means of the instantaneous measurement of speed, flow gradients, wall shear stress and vessel wall stiffness. We conducted an investigation of different hemodynamic patterns according to plaque structure and vascular regional hemodynamics. Two main groups of plaques have been described, the soft ones (“expanding”) and the stiff or hard ones (“non expanding”). The first type has been associated with acute cardiovascular complications and increased cardiovascular risk and just the opposite, chronic lesions in stable disease to the later. We analyze in this paper the characterization of both types of plaques, their hemodynamic patterns and in particular, for the first time, the behavior of the wall shear stress at different sectors of the plaques which may be linked to their development and/or complications. This technology deserves further development face to future applications in the diagnosis and treatment of atherosclerotic vascular disease.
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