Introducing Technical Concepts of Looping Techniques in Endovascular Neurosurgery to Budding Surgeons in Cases of Intracerebral Aneurysms

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

A retrospective review of endovascular procedures at a center in which the Drivewire 24 (DW24) guidewire was used, from its introduction in the authors' department in May 2024 through January 2026, identified several unique technical applications of the DW24 that represent a meaningful advancement in neurointerventional practice.

Modular Robotic Catheters for Endovascular Aneurysm Repair

Fenestrated/Branched endovascular aneurysm repair (FEVAR/BEVAR) require surgeons to navigate catheters and guidewires into various branches of the abdominal aorta, before deploying stent grafts to alleviate pressure on the aneurysm. Previous clinical studies suggests that surgeons continue to struggle with vessel access using standard commercial instruments, prolonging the procedural time and inducing further complications. In this work, we present two contributions to solving this problem: 1) A bespoke 2-segment steerable catheter, consisting of 4 degrees of freedom to enhance dexterity. 2) An expandable, modular tendon-driven actuation platform that can accommodate for the redundancies introduced in our system. To fabricate the catheter, we capitalized on thermal fiber drawing, a technique that creates high-aspect ratio devices at scale, and processed the catheter with laser micro-machining to soften its tip. We evaluated the system using simulations, where we investigated the catheter's bending stiffness, then its steerability with in-vitro experiments in vascular phantoms. This handheld, robotic steerable catheter system has the potential to shorten the length of future endovascular surgeries, and give clinicians the tools to resolve challenging clinical cases.

Single Center Experience using Fiber Optic RealShape (FORS) Technology in Patients Treated with Complex Endovascular Aneurysm Repair.

Fiber Optic RealShape has an acceptable technical success rate in visceral TV catheterization during cEVAR, which has improved following the 3D-Hub implementation, supporting initial FORS use in all catheterizations to minimize radiation.

Rotating SIM Technique—A Novel Technique for Retrieval of Retained Guidewire from Internal Iliac Vein

Abstract As the number of endovascular procedures is increasing, the incidence of intravascular foreign body (IFB) is also on a rising trend. Broken catheter fragments or leftover guidewires are common IFB. These foreign bodies can embolize, causing injury to vital structures or may cause vascular thrombosis. Standard snare retrieval techniques may fail when the accessible end of the foreign body lies deep within a small or acutely angled branch vessel. We describe a branch vein-specific Simmons (SIM)-based rotational repositioning variant that enables the retrieval of a retained guidewire impacted in the internal iliac vein. A 39-year-old male patient with chronic kidney disease presented with a retained guidewire in the venous system after placement of a dialysis catheter in the right internal jugular vein. The J-tip of the guidewire was lodged deep into the right internal iliac vein, and retrieval of the guidewire by grasping its tip and snaring using a standard loop snare was not feasible. The proximal end was also not thought to be safely retrievable by simply pulling out the catheter because it could not be easily accessed for manual extraction. Taking out the catheter could have caused the guidewire to further migrate and loss of the only functioning dialysis access. So, a reverse curved catheter (SIM1) was used to engage the guidewire in its primary curve. After engagement, the catheter-guidewire combination was pushed up, placing the guidewire in the right common iliac vein, from where it was snared out. Our case describes a practical use of a reverse curved catheter (SIM1) to engage and displace intravascular retained foreign body lodged deep in the internal iliac vein. We propose that this technique is an easy and effective technique to reposition foreign bodies from anatomically difficult regions to more favorable locations from where snaring can be easily performed.

Endovascular Management of Type 2 Endoleak after Endovascular Aneurysm Repair: An Interventional Radiologist's Perspective

Type 2 endoleak (T2EL) is the most common complication after endovascular aneurysm repair (EVAR), occurring in 10%–25% of patients. Although many T2ELs follow a benign course, persistent T2EL is associated with sac expansion, secondary endoleaks, rupture, and aneurysm-related mortality. Endovascular treatment is indicated in cases of progressive sac growth and is broadly divided into the transarterial approach and the direct sac puncture approach—the latter encompassing transabdominal, translumbar, and tran-scaval routes. Each approach has distinct technical advantages and limitations, and selection should be tailored to the source vessel of the endoleak, sac location, surrounding anatomy, and patient-related factors. Coils, N-butyl cyanoacrylate, and ethylene vinyl alcohol copolymer (Onyx) constitute the principal embolic agents, with liquid embolics showing improved durability over coils alone in recent comparative studies. Prophylactic embolization of the inferior mesenteric artery, lumbar arteries, or the aneurysm sac during EVAR has recently emerged as a promising preventive strategy. This review summarizes the current approaches, embolic materials, prophylactic strategies, and clinical outcomes of T2EL management from the perspective of the interventional radiologist.

Feasibility of a novel multi-device robotic system for multiple neurointerventional procedures: pre-clinical validation in porcine models