Computed tomography (CT) angiography is the main method for the initial evaluation of cerebral circulation in acute stroke. A comprehensive CT examination that includes a review of the three-dimensional and maximum-intensity projection images of the main intra and extracranial arteries allows the identification of most abnormalities and normal variants. Anatomical knowledge of the presence of any normal variants, such as fenestration, duplications, and persistent fetal arteries, plays a crucial role in the diagnosis and therapeutic management of acute stroke. However, the opposite is also true. In fact, sometimes it is the clinical picture that allows weighing how relevant or not the alteration found is. Therefore, in this review, a concise representation of the clinical picture attributable to a given arterial vessel will be included.
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