Improving catheter navigation in neurointerventional procedures: single-center insights on next-generation steerable guidewires

Purpose Steerable guidewires with deflectable tips enable real-time navigation through complex cerebrovascular anatomy without requiring wire removal and tip reshaping. Despite promising early reports, systematic clinical evaluation remains limited. Methods We conducted a retrospective analysis of 58 consecutive neurointerventional procedures utilizing steerable guidewires at two centers from September 2024 to August 2025. The cohort comprised 48 cases using the Drivewire 24 (DW24, 0.024-inch diameter) and 10 cases using the Artiria SmartGUIDE (0.014-inch diameter). Primary outcomes included technical success, safety profile, and operator assessment. We also performed a scoping literature review of all published steerable guidewire studies in neurointerventional applications. Results Technical success in reaching target vessels was achieved in 100% of cases for both systems with no intraoperative or postoperative complications. Mean fluoroscopy time was 32.7 ± 29.5 min for DW24 and 26.1 ± 16.2 min for Artiria procedures. Treatment indications included aneurysm procedures (53.4%), diagnostic angiographies (20.7%), venous sinus stenting (13.8%), middle meningeal artery embolizations (8.6%), and stroke interventions (3.4%). 8.3% of procedures using DW24 were considered higher-risk by the primary operator without steerable capability, including successful navigation of complex posterior circulation anatomy in giant basilar aneurysms and recurrent superior cerebellar artery aneurysms with prior stent constructs. Our limited experience with the Artiria system ( n = 10) revealed operator-noted challenges with shape retention. The scoping review identified only three prior studies encompassing 65 procedures, establishing this as the largest reported experience. Conclusion Both steerable guidewire systems achieved perfect technical success with excellent safety profiles. Based on our preliminary experience, the DW24 appeared to offer advantages for procedures requiring navigating larger catheters through tortuous anatomy. These findings support selective clinical use of steerable guidewire technology in challenging neurointerventional procedures.