Endovascular treatment in peripheral and coronary circulations has been greatly advanced with the aid of intravascular imaging such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Studies have shown that these technologies have a clinical impact, such as reducing in-hospital adverse events and improving long-term survival following coronary artery stenting. For the intracranial circulation, however, translation and routine use of such intravascular imaging has lagged, owing to the unique tortuosity of the neurovasculature. Specifically, complexities around both miniaturization of the imaging probe with appropriate flexibility and a solution for distal rotational control (eg, replacement of the torque cable that experiences high friction within the catheter construct in tortuous vessels) are difficult to overcome.