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Review
Preclinical testing platforms for mechanical thrombectomy in stroke: a review on phantoms, in-vivo animal, and cadaveric models
  1. Yang Liu1,
  2. Mehdi Abbasi1,
  3. Jorge L Arturo Larco2,
  4. Ramanathan Kadirvel1,
  5. David F Kallmes1,
  6. Waleed Brinjikji1,
  7. Luis Savastano2
  1. 1Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Luis Savastano, Neurosurgery, Mayo Clinic Rochester, Rochester, MN 55905, USA; Savastano.luis{at}mayo.edu

Abstract

Preclinical testing platforms have been instrumental in the research and development of thrombectomy devices. However, there is no single model which fully captures the complexity of cerebrovascular anatomy, physiology, and the dynamic artery-clot-device interaction. This article provides a critical review of phantoms, in-vivo animal, and human cadaveric models used for thrombectomy testing and provides insights into the strengths and limitations of each platform. Articles published in the past 10 years that reported thrombectomy testing platforms were identified. Characteristics of each test platform, such as intracranial anatomy, artery tortuosity, vessel friction, flow conditions, device-vessel interaction, and visualization, were captured and benchmarked against human cerebral vessels involved in large-vessel occlusion stroke. Thrombectomy phantoms have been constructed from silicone, direct 3D-printed polymers, and glass. These phantoms represent oversimplified patient-specific cerebrovascular geometry but enable adequate visualization of devices and clots under appropriate flow conditions. They do not realistically mimic the artery-clot interaction. For the animal models, arteries from swine, canines, and rabbits have been reported. These models can reasonably replicate the artery-clot-device interaction and have the unique value of evaluating the safety of thrombectomy devices. However, the vasculature geometries are substantially less complex and flow conditions are different from human cerebral arteries. Cadaveric models are the most accurate vascular representations but with limited access and challenges in reproducibility of testing conditions. Multiple test platforms should be likely used for comprehensive evaluation of thrombectomy devices. Interpretation of the testing results should take into consideration platform-specific limitations.

  • thrombectomy
  • device
  • intervention
  • stroke
  • blood flow

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Footnotes

  • Contributors YL, WB, and LS conceived of the study and study design. YL, MA, and JLAL performed data acquisition, analysis, and interpretation. YL drafted the article. The article was critically revised by YL, RK, DFK, WB, and LS. RK, DFK, WB, and LS provided administrative, technical, supervisory, or other support. All authors reviewed the submitted version, and LS approved it on behalf of all authors. YL and LS are guarantors of the integrity of entire study.

  • Funding This work was supported by National Institute of Health grant number NS105853.

  • Competing interests LS is the founder and stake-owner of Endovascular Engineering, Inc., which develops thrombectomy technologies. YL serves on this company’s Scientific Advisory Board.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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