A hyper-viscoelastic uniaxial characterization of collagenous embolus analogs in acute ischemic stroke

Purpose: Acute ischemic stroke is a leading cause of death and morbidity worldwide. Despite advances in medical technology, nearly 30% of strokes result in incomplete vessel recanalization. Recent studies have demonstrated that clot composition correlates with success rates of mechanical thrombectomy procedures. To understand clot behavior during thrombectomy, which exerts considerable strains on thrombi, in vitro studies must characterize the rate-dependent high-strain behavior of embolus analogs (EAs) with different formation conditions, which can be used to fit models of hyper-viscoelasticity. Methods: In this study, the effect of collagen infiltration as a carotid-induced collagen-rich thrombosis surrogate is considered as a contributor to embolus analog high-strain stiffness, when compared to 40% hematocrit EAs. Results: EA high-strain stiffnesses, characterized on a uniaxial load frame, increase by an order of magnitude for collagenous clot analogs. Chandler loop analogs show high-strain stiffnesses and clot compositions commensurate with previous reports of stroke patient clots, and collagenous clots show significant increase in stiffness when compared to stroke patient clots. Finally, hyper-viscoelastic curve fitting demonstrates the asymmetry between tension and compression. Nonlinear, rate-dependent models that consider clot-stiffening behavior match the high strain stiffness of clots fairly well. Furthermore, we demonstrate that the stability of the elastic energy needs to be considered to obtain optimal curve fits for high-strain, rate dependent data. Conclusion: This study provides a framework for the development of dynamically formed EAs that mimic the mechanical and structural properties of in vivo clots and provides parameters for numerical simulation of clot behavior with hyper-viscoelastic models.