Journal: European Journal of Radiology Open
Article Title: Preliminary results of 3D MRI-DSA fusion for navigation planning in endovascular recanalization of chronic intracranial artery occlusion
doi: 10.1016/j.ejro.2026.100742
Figure Lengend Snippet: Fusion-guided endovascular attempt, iatrogenic perforation, and coil embolization . (A) Digital subtraction angiography (DSA) confirms RICA occlusion from C4 to C6; three-dimensional (3D) rotational images were obtained. Under general anesthesia, a 6 F guiding catheter (Envoy, Cordis) was positioned at C1, and a 0.014-inch Synchro-14 microwire (200 cm; Stryker) with a microcatheter (Excelsior SL-10, Boston Scientific) was advanced coaxially. (B–D2) A 3D MRI–DSA fusion overlay served as an adjunct roadmap overlay supporting navigation planning and intra-procedural orientation during traversal through C4–C5. (D5) Mismatch with the fusion overlay prompted early suspicion of wire deviation beyond the virtual arterial wall while attempting to cross C6. (D6) Microcatheter contrast injection demonstrates subarachnoid extravasation (“storm cloud” sign), confirming perforation. (D7, D8) Two detachable coils (Guglielmi Detachable Coils, 4 mm × 8 cm and 3 mm × 6 cm) were deployed at C6, achieving hemostasis. (E–G) Post-procedural non-contrast CT reveals subarachnoid hemorrhage in the bilateral occipital lobes and along the tentorium, which resolved on days 1–2. The patient was discharged on aspirin 300 mg daily (indefinite) and clopidogrel 75 mg daily (3 months), with no recurrent symptoms at 3-month follow-up.
Article Snippet: Under general anesthesia, a 6 F guiding catheter (Envoy, Cordis) was positioned at C1, and a 0.014-inch Synchro-14 microwire (200 cm; Stryker) with a microcatheter (Excelsior SL-10, Boston Scientific) was advanced coaxially. (B–D2) A 3D MRI–DSA fusion overlay served as an adjunct roadmap overlay supporting navigation planning and intra-procedural orientation during traversal through C4–C5. (D5) Mismatch with the fusion overlay prompted early suspicion of wire deviation beyond the virtual arterial wall while attempting to cross C6. (D6) Microcatheter contrast injection demonstrates subarachnoid extravasation (“storm cloud” sign), confirming perforation. (D7, D8) Two detachable coils (Guglielmi Detachable Coils, 4 mm × 8 cm and 3 mm × 6 cm) were deployed at C6, achieving hemostasis. (E–G) Post-procedural non-contrast CT reveals subarachnoid hemorrhage in the bilateral occipital lobes and along the tentorium, which resolved on days 1–2.
Techniques: Injection