From in vitro blood rheology to useful bedside instrumentation for cardiovascular diseases: history and challenges.

I present an historical overview beginning with Prof. Harry L. Goldsmith, my first summer research supervisor in 1963 in microrheology, evolving years later to introduction into my laboratories at McGill University of the coaxial cylinder couette flow device for dynamic, real-time measurements of platelet aggregation in platelet suspensions sheared up to 8000/s, analyzed with a flow cytometer, and finally to a technology transfer of this rheological approach toward the marketplace. I and collaborators observed the shear-dependent roles of different adhesive receptors in mediating human platelet aggregation, and the importance of shear in evaluating efficacy of antiplatelet drugs, in contrast to studies with a classical aggregometer. I outline the well-published rationale for using flow devices, such as the coaxial cylinder couette, to assist clinicians and health managers assess the drug and clinical outcome efficacy of antithrombotic drugs in cardiovascular diseases, as well as their future applications.