A85 Preclinical to clinical translation in mechanical thrombectomy: a systematic review and meta-analysis of in vivo stroke models compared with clinical outcomes

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Background/Introduction Preclinical models are critical in development and evaluation of novel mechanical thrombectomy (MT) devices for acute ischemic stroke (AIS); yet reported efficacy and safety outcomes often do not translate clinically. Despite many reviews, performance comparisons across models and translational relevance remain limited. Objective/Purpose This systematic review assesses model performance, translation to clinical practice, and provides insights into experimental design. Methods/Case Description A systematic search was performed using Pubmed, Scopus and Ovid MEDLINE to identify in vivo studies evaluating MT. Studies lacking extractable efficacy/safety outcomes were excluded. Clinical benchmarks were extracted from HERMES meta-analysis trials. The primary outcome assessed recanalization rates, (m)TICI≥2b. Data on vessel/clot characteristics, procedural efficacy, and safety were extracted. Graphpad was used for statistics (p<0.05=significant). Results/Findings 1160 articles were screened; 41 included. Swine and canine were most used. Canine models demonstrated slightly higher (m)TICI≥2b (98.6% vs 91.6%, p>0.05). FPE, mean attempts, vasospasm, time to recanalization, and vessel injury were comparable (p>0.05) between models, except thromboembolic events (28.6% vs 4.6%,p<0.05). Compared with patients, both models overestimated clinical (m)TICI≥2b (71.2% vs 91.6-98.6%,p<0.05). Hemorrhagic events (16.2%) and mortality (14.5%) were almost negligible in animals compared to patients. Animal experienced higher vasospasm (31–42% vs 9%,p<0.05). Swine models approximated clinical thromboembolic events (4.6% vs 6.0%,p>0.05). Thrombectomy was performed 5-180 minutes post-occlusion vs 6–8 hour window accepted in guidelines. No functional outcomes comparable to modified Rankin Scale (primary endpoint in clinical trials) were reported. Discussion/Conclusions/Learning Points Preclinical MT models are valuable but present translational limitations; overestimating recanalization and underestimating complications like hemorrhage and mortality. These findings highlight the need for improved model design, standardized reporting, and clinically relevant endpoints.

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