We describe our preliminary experience using a road-mapping procedure that involves combining preacquired CTA with real-time fluoroscopy. This maneuver facilitates navigation in supra-aortic vessels from the arch to skull base levels. It requires less contrast than is used for traditional road-mapping while potentially reducing the hazard of thromboembolic events associated with direct catheterization. The accuracy of registration between the 2 volume datasets seems satisfactory for clinical practice.