1with these numbers expected to increase as the population ages in the coming decades. 2 The cerebrovascular system is particularly sensitive to injury, with disruptions in cerebral perfusion being the fourth leading cause of death in the United States.1 Timely restoration of normal blood flow and reconstitution of cerebral macrovasculature is critical in patients with cerebrovascular pathology. Endovascular interventions have shown promise for a variety of cerebrovascular diseases, and thrombectomy procedures continue to be a subject of ongoing research and trials for the treatment of ischemic stroke resulting from large-vessel occlusion. [3][4][5][6][7] Early clinical trials studying mechanical embolectomy demonstrated a decoupling of clinical outcomes with the degree of angiographic reperfusion [8][9][10] ; these findings may reflect challenges in patient selection, inadequate reperfusion with first-generation devices, or reperfusion-related injury. 3,7 Clinical trials with second-generation devices are currently ongoing to elucidate the role of adequate, timely mechanical reperfusion in patients with large-vessel strokes. 4,5 Given this clinical need, vascular endothelial cell (EC) damage resulting from altered flow dynamics, reperfusion injury, or iatrogenic trauma represents a potentially important source of secondary neuronal injury that merits further study. 11,12 As modern thrombectomy devices focus on rapid and complete revascularization, considerations of the degree of EC injury have substantial clinical and design implications.The cerebral endothelium is a dynamic biological system that regulates blood brain barrier (BBB) permeability, autoregulates cerebral microcirculation via nitric oxide pathways, and mediates cerebral inflammation via release of tumor necrosis factor-α, interleukin 1β, and interleukin 6. We have previously demonstrated that physiological blood flow and resultant shear stress are crucial for EC maintenance and remodeling after injury [13][14][15][16][17][18][19][20][21][22] and that locally disrupted blood flow contributes to inflammatory cascades. 23 Many of the proposed mechanisms of reperfusion injury after acute ischemic stroke also originate at the EC level.Background and Purpose-Endovascular thrombectomy has shown promise for the treatment of acute strokes resulting from large-vessel occlusion. Reperfusion-related injury may contribute to the observed decoupling of angiographic and clinical outcomes. Iatrogenic disruption of the endothelium during thrombectomy is potentially a key mediator of this process that requires further study. Methods-An in vitro live-cell platform was developed to study the effect of various commercially available endovascular devices on the endothelium. In vivo validation was performed using porcine subjects. Results-This novel in vitro platform permitted high-resolution quantification and characterization of the pattern and timing of endothelial-cell injury among endovascular thrombectomy devices and vessel diameters. Thrombectomy devices displaye...