A temporal homogenization approach for the numerical simulation of atherosclerotic plaque growth is extended to fully coupled fluid-structure interaction (FSI) simulations. The numerical results indicate that the two-scale approach yields significantly different results compared to a simple heuristic averaging, where only stationary long-scale FSI problems are solved, confirming the importance of incorporating stress variations on small time-scales. In the homogenization approach, a periodic fine-scale problem, which is periodic with respect to the heart beat, has to be solved for each long-scale time step. Even if no exact initial conditions are available, periodicity can be achieved within only 2–3 heart beats by simple time-stepping.@en