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Angiogenesis within atherosclerotic plaques is a critical determinant of plaque stability. The biomechanical microenvironment, consisting of fluid shear force, plaque structural stress, and matrix stiffness, serves as significant factors in mediating plaque angiogenesis. Endothelial cells respond to mechanical signals and participate in plaques neovascularization through force chemical signal transduction mechanisms. This review provides an overview of the mechanisms by which mechanical factors regulate angiogenesis within plaques and offers a novel therapeutic approach for the prevention and treatment of atherosclerosis.