![]() CT Neuroangiography: A Glance at the Common Pitfalls and Their Prevention. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals from a Special Writing Group of the Stroke Council, American Heart Association. Vascular Malformations of the Brain and Spine. Multislice CT Angiography in the Selection of Patients with Ruptured Intracranial Aneurysms Suitable for Clipping or Coiling. Westerlaan H, Gravendeel J, Fiore D et al. Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms. Philipp L, McCracken D, McCracken C et al. Whether or not to include a non-contrast and/or post-contrast brain will depend on local protocol and indications for the scan. If unsure whether to include the carotid arteries and perform a CTA carotids, seek a radiologist's opinion. Some venous opacification is unavoidable as the circulation time from arteries to veins is around 3-6 seconds 5. While contrast within the venous system denotes that the scan is late, this usually does not warrant repeat imaging if the circle of Willis is well opacified. Pay attention to any bony opacities on the monitoring slice before the injection of contrast to ensure there is no confusion as contrast begins to perfuse the arterial circulation. Structures such as the styloid processes may be mistaken for arterial blush if the operator is overly zealous. Take care when monitoring for contrast to appear before manually triggering the helical acquisition. minimal scan delay: wait for approximately 5 seconds before contrast monitoring.60 mL of non-ionic iodinated contrast with 50ml saline bolus at 4.5/5 mL/s.18 g to 20 g in antecubital fossa (preferably).manual trigger when contrast is seen within vertebral/carotid arteries.hard palate perpendicular to the table (chin down).supine with arms by the patient’s side.previous severe reactions to iodinated contrast.Ideally, there should be minimal contrast within the dural venous sinuses such an instance indicates that the timing is somewhat late. ![]() The purpose of a CTA COW is to achieve maximum opacification of the circle of Willis in order to identify vascular structure abnormalities or bleeding subarachnoid vessels.
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