{
  "abstract": "Introduction Intracerebral hemorrhage (ICH) affects over 80,000 Americans annually, carrying a 40% 30-day mortality rate and leaving 80% of survivors with long-term disability. ENRICH trial (2024) established Level I evidence that minimally invasive surgery (MIS) with near-complete clot evacuation (>70%) performed within 24hours—ideally within 8 hours—significantly improves functional outcomes. However, current MIS platforms require stereotactic neuro navigation systems, rigid head fixation, specialized OR infrastructure, and multi-device setups that result in median door-to-OR times exceeding 13 hours. The VECTOR (Volumetric Entry and Cranial Targeting with On-demand Radiography) Brain Access System (Angiotronix, Inc) was developed to enable rapid, frameless, fluoroscopy-guided ICH targeting directly within the neuro angiosuite, leveraging existing flat-panel CT and stroke team infrastructure without additional capital equipment.Methods A high-fidelity cadaveric ICH model was developed and validated using fresh, never-frozen human head-and-neck specimens. Human-derived thrombi were fabricated from 95% fresh frozen plasma (FFP) and 5%packed red blood cells (pRBCs), augmented with iohexol contrast (0.75 mL Omnipaque per 50mL clot) to enable radiographic detection. Rheometric profiling confirmed that this formulation best approximated the viscoelastic properties of native human ICH (storage modulus G′≈878Pa;tanδ≈0.23). Thrombi were implanted into temporal, frontoparietal, and occipital lobes (baseline volumes:30-80mL) via a transorbital approach. Five proceduralists performed 14 simulated ICH targeting procedures using the VECTOR system (Angiotronix, Inc) on a Siemens ARTIS icono biplane angiography system with DynaCT. The workflow consisted of: (1) flat-panel CT acquisition (∼19 seconds); (2) trajectory planning using Syngo Needle Guidance software; (3) C-arm alignment to the planned entry-to-target trajectory; (4) burr hole creation; and (5) fluoroscopically guided advancement of the VECTOR sheath into the hematoma. Targeting accuracy was assessed on post-placement flat-panel CT and scored as Optimal (trajectory within ±10° of clot longitudinal axis; 50-90% cannula depth within clot), Good (±10-30°; partial clot coverage), or Poor (>30° deviation or cannula outside clot). The pre-specified performance benchmark was ≥90% Optimal or Good. Procedural times (CT-to-incision and incision-to-sheath-in-clot) were recorded. Usability was assessed by Likert scale (1-5).Results VECTOR Brain Access System achieved Optimal or Good targeting accuracy in 100% (14/14) of cases, exceeding the pre-specified benchmark of ≥90%. Of these, 87% (12/14) were rated Optimal and 13 (2/14) were rated Good. The two Good cases involved intentional supraorbital trajectory deviation to preserve the globe when a purely longitudinal frontal lobe approach would have traversed the orbit; cannula placement precisely matched the planned trajectory in both instances. Mean CT-to-incision time was 18±7minutes, and mean incision-to-sheath-in-clot time was 6±2minutes. Cadaveric ICH model realism was highly rated by experienced neurosurgeons on Likert-scale survey (radiographic realism: 4.5±0.4; physical realism during simulated evacuation: 4.8±0.2). End-user usability of the VECTOR system was rated 4.6±0.3 out of 5. Operators consistently highlighted intuitive fluoroscopic alignment, seamless integration with existing flat-panel CT workflows, and the ability to perform pre-, intra-, and post-procedural imaging without moving the patient or breaking sterility.Conclusion VECTOR Brain Access System demonstrated 100% clinical-grade targeting accuracy for ICH in a validated human cadaveric model, without rigid head fixation, stereotactic navigation systems, or specialized OR infrastructure. Rapid CT-to-incision times and high usability scores support the feasibility of frameless, fluoroscopy-guided ICH targeting within the neuro angiosuite using existing stroke team workflows. These preclinical results support clinical translation of the VECTOR system for ultra-early, minimally invasive ICH evacuation.Disclosures Y. Senol: None. N. Krishnan: None. P. Kumar: None. N. Krishnan: None. D. Leong: None. S. Ma: 5; C; Siemens Medical Solutions USA Inc. A. Ganguly: 4; C; Siemens Medical Solutions USA Inc. 5; C; Siemens Medical Solutions USA Inc. K. Mueller: 4; C; Siemens Healthineers AG. 5; C; Siemens Healthineers AG. D. Cooke: None. L. Savastano: 1; C; Siemens Medical Solutions USA Inc.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "Y Senol"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "N Krishnan"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "P Kumar"
    },
    {
      "affiliations": [
        "UCLA, Los Angeles, CA"
      ],
      "name": "A Liu"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "N Krishnan"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "D Leong"
    },
    {
      "affiliations": [
        "Advanced Therapies Innovation, Siemens Medical Solutions USA Inc,, Malvern, PA"
      ],
      "name": "S Ma"
    },
    {
      "affiliations": [
        "Advanced Therapies Innovation, Siemens Medical Solutions USA Inc, Malvern, PA"
      ],
      "name": "A Ganguly"
    },
    {
      "affiliations": [
        "Neurovascular, Siemens Healthineers Endovascular Robotics Inc, Newton, MA"
      ],
      "name": "K Mueller"
    },
    {
      "affiliations": [
        "Radiology, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "D Cooke"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Francisco, San Francisco, CA"
      ],
      "name": "L Savastano"
    }
  ],
  "title": "O-025 Hitting the target in the angio suite: fluoroscopy-guided targeting of intracerebral hemorrhage in a human cadaveric model",
  "uid": "4a584c9a-a89a-506a-81be-f92b2649de62"
}