Abstract: This disclosure provides methods for vascular imaging co-registration and using the co-registered imaging data in guiding live fluoroscopy. Extravascular imaging data includes an extravascular contrast image showing the portion of the blood vessel with contrast showing a visualized anatomical landmark while intravascular imaging data is obtained during a translation procedure that includes one or more intravascular images showing a detected anatomical landmark. The starting location and the ending location of the imaging element on the extravascular imaging data is marked, and the predicted location of the detected anatomical landmark on the extravascular imaging data is marked. The predicted location of the detected anatomical landmark is then aligned with the visualized anatomical landmark.