Dynamic real-time 3D roadmap: A navigational tool for endovascular recanalization in chronic intracranial arterial occlusion

Chronic intracranial arterial occlusion (CIAO) poses a significant challenge in neurointerventional practice, with no universally accepted treatment strategy. While endovascular recanalization offers the potential for improved outcomes, it requires precise navigation and visualization of the vascular bed distal to the occluded segment to mitigate risks and enhance procedural success. This study introduces a novel technique that employs a dynamic real-time three-dimensional (3D) roadmap as a navigation tool during endovascular recanalization procedures for CIAO. This technique leverages advanced 3D rotational angiography and real-time fluoroscopic overlay to provide continuous, high-fidelity visualization of vascular anatomy without the need for repeated angiographic acquisitions or roadmap updates. By eliminating the need for recurrent angiograms to obtain optimal working projections after C-arm adjustments, the dynamic real-time 3D roadmap significantly improves procedural efficiency. This innovation substantially reduces radiation exposure, and contrast media volume, directly enhancing patient safety. Moreover, real-time guidance minimizes procedural complications, such as vessel perforation and dissection, ensuring a safer and more controlled recanalization process. The dynamic real-time 3D roadmap offers a safe, accurate, and efficient approach for navigating complex vascular anatomy, improving clinical outcomes in patients with CIAO while reducing procedural risks and resource utilization.