Objective To evaluate the clinical value of 128-slice spiral CT angiography in diagnosing craniocervical vascular disease. Methods The CT images of 80 patients with documented craniocervical vascular disease were analyzed retrospectively by 2 cardiovascular radiologists. When consistency was obtained by the independent interpretations, the diagnosis of craniocervical vascular disease could be confirmed. Results Among 80 patients examined by CTA, 5 were diagnosed as cerebral aneurysms, and 56 were diagnosed as different degrees of arterial stenosis, which partly involved multivessel, 5 were diagnosed as carotid artery occlusion, 3 were diagnosed as AVM, 3 were diagnosed as moyamoya disease, 1 was diagnosed as dissecting aneurysm of internal carotid artery, 1 was diagnosed as aneurysmal expansion of brachiocephalic artery, 1 was diagnosed as aneurysmal expansion of right common carotid artery, 2 were diagnosed as aneurysmal expansion of galea vein, 3 were diagnosed as subclavical artery. Conclusion 128-slice CT angiography in the diagnosis of craniocervical vascular disease is accurate and rapid characteristics, is worthy of clinical use.