Drivewire24 Steerable Guidewire Enhances Neurovascular Access Outcomes

Introduction/Purpose To evaluate the first in‐human multicenter clinical experience with the Drivewire24 (DW24)—a novel mechanically‐adjustable steerable guidewire—in neurovascular interventions, review the current state of literature, and explore potential future applications. This 0.024 inch, 204 centimeter second‐generation steerable guidewire allows the operator to precisely select vessels by deflecting and shaping the tip in situ using a torque‐like rotational handle. Materials and Methods A non‐consecutive retrospective series of 176 patients who underwent neurovascular procedures involving DW24 use at four North American academic institutions between April 2024‐August 2025 was analyzed. Patient selection for DW24 use was determined preoperatively or intraoperatively at the discretion of the performing interventionalists based upon technical suitability, anatomic, and procedural considerations. Mean patient age was 62.8 years (range 19‐98, SD=14.8), with 74 males (42.0%) and 102 females (58.0%). Treatment indications included ischemic stroke (n=71, 40.3%), aneurysm (n=57, 32.4%), diagnostic cerebral angiogram (n=16, 9.1%), middle meningeal artery embolization (n=7, 12.3%), and other (n=25, 14.2%). Vascular access was via femoral artery (n=86, 48.9%), radial artery (n=74, 42.0%), both femoral and radial artery (n=6, 3.4%), femoral vein (n=5, 2.8%), and other sites (n=5, 2.8%). The DW24 was used as the sole access wire in 48.9% of cases (86/174), or in conjunction with one (38.1%; 67/174) or more (11.9%; 21/174) wires. Outcomes assessed included procedural access success, device malfunctions or failures, and procedural complications. Results The Drivewire24 successfully reached the target vessel(s) in 166/176 patients (94.3%), with partial success in 2 cases (1.1%), but was unsuccessful in 8 cases (4.5%). In cases where DW24 failed, another wire successfully achieved vessel access in 6 of 8 instances (75%). Overall, vessel access was achieved with any wire in 98.3% (173/176) of cases, and operators rated the DW24 wire as easy to use in 96.0% (169/176) of cases. Interestingly, in 20 cases (11.4%), operators deemed the DW24 as essential for successful vessel access, even though other wires were trialed in only 15 of these 20 cases. Intraoperative complications occurred in 5.1% of cases (9/176), including subarachnoid hemorrhage (1.1%; 2/176), microperforation (0.6%; 1/176), thromboembolism (0.6%; 1/176), dissection (0.6%; 1/176), and coil extrusion (0.6%; 1/176). However, no complications were directly related to DW24 use, and there were no DW24‐associated vessel perforations or hardware issues. Conclusion The Drivewire24 is a safe and effective mechanical steerable neurovascular access wire with several advantages over conventional guidewires, including adaptive tip conformation for accurate and efficient vessel selection, as well as excellent catheter anchoring and support. Beyond improving access in complex cases with difficult anatomy, promising novel uses of the DW24 for microcatheter deflection and in situ device manipulation remain to be explored in further clinical applications