Early experience with the SmartGUIDE: A new generation of in-situ deflectable 0.014-inch guidewire

BackgroundNeurointerventional procedures are increasingly complex, requiring access to more distal vasculature. SmartGUIDE 0.014-inch guidewire (Artiria Medical, Geneva, Switzerland) is an FDA-approved dynamic deflectable-tip guidewire, manipulated by an external handle to lock the distal end, allowing active shaping of micro/balloon catheters. We report the first clinical experience using the SmartGUIDE in various neurovascular interventions.MethodsNeurointerventional procedures utilizing the SmartGUIDE from May 2024 to July 2025 were retrospectively analyzed. Clinical outcomes, technical success, and periprocedural complications were assessed. The primary endpoint was successful delivery of a microcatheter tip using the SmartGUIDE to the predefined target without the use of an adjunctive device or microwire. Procedures requiring alternative microwires to replace SmartGUIDE were considered unsuccessful.ResultsThe SmartGUIDE was used in 25 procedures: aneurysm embolization (<i>n = </i>9), arteriovenous malformation/fistula embolization (<i>n = </i>5), tumor embolization (<i>n = </i>4), venous and carotid stenting (<i>n = </i>4), balloon test occlusion (<i>n = </i>2) and endovascular thrombectomy (<i>n = </i>1). SmartGUIDE enabled access to challenging neurovascular targets, successfully reaching the target vessel independently in 24/25; 96% of cases. No device-related complications incurred, such as perforation or dissection. All patients were discharged at their baseline clinical status, except the EVT patient who improved by seven NIHSS points.ConclusionsSmartGUIDE's deflectable-tip wire achieved high technical success and proved safe across various neurointervention. SmartGUIDE improves microcatheter navigation without repeated ex-vivo tip shaping, adjunct tools, or looping through aneurysms. Locking the SmartGUIDE tip can deflect microcatheters and prevent them from herniating into their parent vessel during side branch navigation. Larger studies are needed to evaluate effectiveness across broader clinical indications.