Use of Drivewire 24 guidewire in neurointervention: initial clinical experience and technical advancements

Background Remotely deflectable guidewires are a recently introduced clinical tool in neurointervention. Although their efficacy and safety during early clinical use have been reported, detailed descriptions of technical nuances and advanced applications are limited. Methods We performed a retrospective review of endovascular procedures at our center in which the Drivewire 24 (DW24) guidewire (Rapid Medical, Yokneam, Israel) was used, from its introduction in our department in May 2024 through January 2026. Cases were screened to identify novel technical applications of the DW24. Results The DW24 was used in 48 neurointerventional procedures, including mechanical thrombectomy (n=20), aneurysm treatment (n=12; 2 ruptured and 10 unruptured), dural arteriovenous fistula embolization (n=7), venous interventions (n=4), middle meningeal artery embolization (n=2), superselective cerebral angiography (n=2), and endoleak embolization (n=1). Several novel technical applications of the DW24 were identified and described in detail, accompanied by annotated procedural images. Conclusions Several unique technical applications of the DW24, enabled by the combination of its distinctive diameter and in situ deflectability, represent a meaningful advancement in neurointerventional practice. Several limitations of the DW24, compared with traditional microwires, may reflect the relatively early phase of this technology.