Enhancing Navigation in Neurointerventional Procedures with Steerable Guidewires

Introduction/Purpose Steerable guidewires enable in‐vivo real‐time intravascular tip reshaping without removal, potentially improving navigation capabilities in cerebral vasculature compared to traditional fixed‐tip wires. This study evaluates their safety, efficacy, and usability in neurointerventional cases. Materials/Methods We retrospectively reviewed 58 neurointerventional cases using steerable guidewires (48 Drivewire 24(DW24) and 10 Artiria 0.014 wires) at a large academic medical center from September 2024 to August 2025. Data collected included patient demographics, procedural details, wire performance metrics, complications/outcomes, and operator feedback. Results Among the DW24 cohort, 30 patients were female (62.5%), Mean age was 61.1±13.1 years (range 32‐83), and 31 patients (64.6%) presented with hypertension and 31 (64.6%) with hyperlipidemia. DW24 was the primary wire in all cases (100%), used with one additional wire in 28 cases (58.3%), two wires in 15 cases (31.3%), and three wires in 4 cases (8.3%). Vascular access was via right radial artery in 47 cases (97.9%) and right femoral artery in 1 case (2.1%). Treatment indications included 22 aneurysms (45.8%), 12 diagnostic angiograms (25%), 7 venous sinus stenting procedures (14.6%), 10 MMA embolizations (20.8%), and 1 stroke intervention (2.1%). Catheters navigated over DW24 included sim‐2 glide catheter in 12 cases (25%), XT‐27 in 13 (27.1%), 5F Berenstein catheter in 5 (10.4%), 6F Sofia in 4 (8.3%), and others in 14 (29.2%). Mean fluoroscopy time was 32.7±29.5 minutes (range 2.9‐132.3), with P2Y12 inhibitors/DAPT used in 46 cases (95.8%). Technical success with DW24 successfully reaching target vessels was achieved in all 48 cases (100%), with zero intraoperative or postoperative complications (0%). Operators rated DW24 as easy to use in all 48 cases (100%), with 4 procedures (8.3%) deemed impossible or challenging without DW24.Among the Artiria cohort, 9 patients were female (90%) .Mean age was 58.9±15.3 years (range 37‐78), and 6 patients (60%) presented with hypertension and 6 (60%) with hyperlipidemia. Artiria was the primary wire in all 10 cases (100%), used with one additional wire in 9 cases (90%) and two wires in 1 case (10%). Vascular access was via right radial artery in 6 cases (60%), right femoral artery in 1 (10%), right groin in 2 (20%), and right cephalic vein in 1 (10%). Treatment indications included 9 aneurysms (90%) and 1 venous sinus stenting procedure (10%). Mean fluoroscopy time was 26.1±16.2 minutes (range 3.9‐48.9), with P2Y12 inhibitors/DAPT used in all 10 cases (100%). Technical success was achieved in all 10 cases (100%), with zero intraoperative or postoperative complications (0%). Operators rated the Artiria wire as more difficult to use compared to DW24 and less reliable with reusability & shape retention. In addition, the 0.014 diameter of the artiria wire made it less versatile with larger intermediate and microcatheters. Conclusion Both steerable guidewires demonstrated excellent safety and efficacy in neurointerventional procedures, with DW24 offering superior usability over Artiria based on operator feedback. Steerable guidewire technology offers a safe and effective alternative for navigating cerebrovascular anatomy, particularly in cases deemed challenging with conventional wires.