A Systematic Review of in vitro Modeling and Experimentation for Cerebral Thrombectomy: Applications, Insights, and Future Directions

This systematic review focuses on in vitro research exploring specific aspects of cerebral thrombectomy. It highlights the principal applications of this research, important insights from the published literature, and areas in which controlled and reproducible in vitro experimentation may provide particular value. Predetermined inclusion and exclusion criteria were set and the Public/Publisher MEDLINE (PubMed) database was searched to identify relevant peer-reviewed articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 92 articles were included in the qualitative review and grouped into 8 broader themes according to the principal application of the in vitro experiment and primary research question: (1) device evaluation and preclinical development, (2) thrombectomy techniques and device manipulation, (3) vessel geometry and morphology, (4) hemodynamics, (5) robotic thrombectomy, (6) angiographic clot localization, (7) in vitro validation of in silico models, and (8) clot characteristics and vessel interaction. Marked methodological heterogeneity precluded quantitative synthesis or meta-analysis. Rather than seeking to establish the comparative superiority of individual devices or techniques, this review qualitatively synthesizes how in vitro experimentation has been applied to cerebral thrombectomy and what it has demonstrated. Three areas were identified as particularly suited to further controlled in vitro investigation: vascular compliance, anatomical location of vessel occlusion, and validation of in silico models. Limitations of both in vitro experimentation and the review methodology are acknowledged, and correlation with clinical practice remains essential where possible.