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We agree entirely with Dr Kaneda that both the local endothelial shear stress (ESS) stimulus and the local atherosclerotic plaque change may occur in a highly focal manner within each 3-mm segment, and one must look at both ESS and the arterial wall in portions of the wall circumference to assess plaque behavior accurately. In our original article,1 we were limited by space to describe the effect of focal ESS on focal plaque progression around the circumference of the 3-mm segment, but we presented those results from a database study at the American Heart Association Scientific Sessions in 2012.2 Focal eccentric plaque growth in a portion of the circumference of the arterial wall is indeed strongly related …

circulation

Response to Letter Regarding Article, “Prediction of Progression of Coronary Artery Disease and Clinical Outcomes Using Vascular Profiling of Endothelial Shear Stress and Arterial Plaque Characteristics: The PREDICTION Study”