Background: To discuss the technique of 64-slice spiral CT subtraction angiography (64-SCTSA) in head and neck, and evaluate its clinical application. Patients and methods: 84 patients suspected of head-neck vascular diseases were examined with 64-SCTSA. The examination techniques, image quality and clinical application were retrospectively analyzed, and the diagnoses of 64-SCTSA were compared with those of surgery or DSA. Results: Eighty-four subjects were successfully examined with 64-SCTSA, whose scanning and imaging parameters are effective. Image quality was excellent in 51 cases (60.7 %), good in 29 (34.5 %) and acceptable in 4 (4.8 %). In the 84 subjects, 79 cases were found abnormal in blood vessel (58 in head and 21 in neck), of which 57 were confirmed by surgical operation or digital subtraction angiography (DSA). Conclusions: 64-SCTSA is a feasible technique with satisfactory image quality and has the advantages of showing the lesions of vasculature without shelter from bone. It can improve the diagnostic accuracy in head-neck vascular diseases.