Indications for CTA arch to COW in blunt trauma to rule out BCVI (blunt cerebrovascular
injury)
If possible we should try to define the indications for CTA arch to COW before the patient goes to the CT
suite. For the most part, the indications below are in the setting of major acceleration or deceleration
injury.
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GCS less than or equal to 6
Major facial smash (Lefort 2 or 3 or jaw fracture)
Seat belt sign on neck
Major chest trauma (hemopneumothorax, multiple rib fractures, first rib fracture)
Ligature strangulation or hanging
Evidence of basal skull fracture
Signs or arterial injury (hematoma, bruit less than age 50, Horners syndrome, arterial
hemorrhage from mouth or nose or ears
After a patient returns from CT scan there may be indications for a patient to go back to the CT scan
suite for CTA arch to COW. These are:
1. Neurologic deficit inconsistent with the CT head (i.e. suspicion of a stroke)
2. Basilar skull fracture involving carotid foramen
3. C spine fracture or ligamentous injury