Overlying Fluoroscopy and Preacquired CT Angiography for Road-Mapping in Cerebral Angiography

A 68-year-old woman was referred for diagnostic angiography of an aneurysm in the cavernous portion of the internal carotid artery. A, AP view of real-time fluoroscopy with superimposition of an MIP of a previously acquired CTA. A 5F Bern catheter (Boston Scientific, Natick, Massachusetts) with a Terumo wire (Terumo Medical, Somerset, New Jersey) can be seen in the brachiocephalic trunk. B, The wire is shown in the proximal right common carotid artery. The superimposed MIP of the CTA does not correlate well with fluoroscopy due to the different depth of the aortic arch and the proximal common carotid artery in the AP projection. C, After manual adjustment of the depth of the MIP, the road-mapping of distal vasculature until bifurcation is available again for further navigation of the catheter. Arrows indicate the tip of the catheter, and the arrowheads indicate the tip of the wire.