Access and Direct Coil Placement in Complex Neurovasculature with a Novel 2.0 Fr SwiftNINJA (Leonis Mova Selective) Steering Microcatheter: A Technical Note.

Abstract

The 2.0 Fr SwiftNINJA (Leonis Mova Selective, Merit Medical/SB Kawasumi) is the lowest profile steerable microcatheter available, designed to optimize navigation through tortuous vascular anatomy in neurointerventional procedures. This study assesses the clinical utility of the 2.0 Fr SwiftNINJA microcatheter for navigating small-caliber cerebral vessels and delivering therapeutic devices, as demonstrated in a case involving the inferior lateral trunk (ILT), a challenging branch of the internal carotid artery. We reviewed the case of a man in his 30s diagnosed with a sphenoid wing meningioma supplied by the ILT. A patient-specific vascular model was created for preprocedural simulation to evaluate access feasibility and guide procedural planning. Both the simulation and subsequent embolization were performed using the 2.0 Fr SwiftNINJA, which features a 2.0 Fr tip and a 0.0160-inch inner lumen, enabling navigation through narrow, sharply branching vessels. Preprocedural simulation accurately predicted the difficulty of accessing the ILT and informed the strategy. During the procedure, the distal tip of the 2.0 Fr SwiftNINJA was controlled by rotating the proximal handle dial, allowing the operator to deflect the tip toward the ILT and align it with the target vessel. The microcatheter was advanced as planned, and direct coil embolization was performed. Postprocedural angiography confirmed effective occlusion of the ILT with preservation of adjacent vasculature. The 2.0 Fr SwiftNINJA steerable microcatheter provides precise, controlled access and device delivery in anatomically challenging, small-diameter vessels. This case illustrates its potential to broaden the scope of neurointerventional treatment in complex cerebrovascular anatomies.