Biomechanics in Small Artery Remodeling

In this chapter, we discuss how biomechanical forces influence vascular design. We will focus on the small arteries and arterioles, i.e., those vessels that together cause the majority of resistance for perfusion. We will do so because pathological alteration in the caliber of these resistance vessels, “remodeling,” is related to both hypertension and impaired local perfusion reserve and tissue ischemia. We will discuss the definitions of remodeling, its role as part of normal homeostasis, and its involvement in a range of pathologies. Subsequently, we address the evidence for the involvement of wall shear stress and wall stress under normal and pathological conditions, the need for an integrative, “systems level” understanding, and the translational perspectives of interfering with the regulation of resistance vessel structure.