In Vitro Clot Modeling and Clinical Applications

Stroke is a leading cause of death and disability in the USA and poses a significant economic burden to society. According to the heart disease and stroke statistics from 2018, an additional 4% of the adult population will have experienced a stroke by 2030. Recent randomized controlled trials have demonstrated a convincing benefit from stent retriever-mediated mechanical thrombectomy for selected acute ischemic stroke (AIS) patients with large vessel occlusion in the anterior circulation. Early reperfusion of ischemic penumbra is associated with favorable outcomes and reduced mortality. The dependencies of the efficacy and safety of endovascular treatment on clot composition and mechanics were highlighted in prior studies. Understanding the clot composition prior to thrombectomy using imaging modalities such as MR or CT may help determine the most appropriate treatment strategy. Current in vitro clot modeling techniques produce clinically representative clot analogs with different mechanical features for device efficacy testing and with various histological patterns for improving clot imaging quality. In this chapter, we will review several methods of clot preparation and characterization and discuss the clinical applications of the clot analogs.