Objective To explore the clinical value of spiral CT angiography (SCTA) clinical value in acute cerebral infarction patients. Methods The data of patients with acute cerebral infarction who admitted to our hospital from October 2015 to October 2016 were analyzed. Before treatment, all patients underwent digital subtraction angiography (DSA), neck vascular ultrasound (CVUS) and SCTA. DSA results were used as the reference standard to compare the detection rate of carotid stenosis, the rate of carotid stenosis, the degree of carotid stenosis and the detection rate of carotid plaque between CVUS and SCTA examinations. Results The detection rates of carotid stenosis detected by SCTA and CVUS were 52% and 50% respectively, and the difference was not statistically significant (P>0.05). The rates of carotid stenosis detected by SCTA and CVUS were (32.98±10.92)% and (31.07±10.33)% respectively, and there was no significant difference between the two groups (P>0.05). The accuracy rate of carotid stenosis detected by SCTA and CVUS was 74% and 46% respectively, and the difference was statistically significant (P<0.05). The SCTA and CVUS detected the number of carotid plaques were 110 and 87 respectively, the plaque detection rates were 93.22% and 73.73% respectively, the difference was statistically significant (P<0.05). Conclusion Compared to the same noninvasive CVUS, SCTA can not only better assess the stenosis of carotid artery, but also detect the arterial plaque in patients with acute cerebral infarction better.