Objective To analyze the application value of rotational digital subtraction angiography （DSA） three-dimensional （3D） reconstruction in the diagnosis and identification of cerebrovascular diseases. Methods From January 2016 to January 2018， a total of 80 patients with suspected cerebrovascular disease in the radiotherapy intervention room of our hospital were selected. All patients were examined with conventional DSA and rotational DSA 3D reconstruction technologies. The display results and diagnosis positive rate of cerebrovascular disease by the two examination methods were observed. The relationship between the aneurysmal neck and the parent artery displayed by the two methods was compared. Results Conventional DSA found 59 cases of intracranial aneurysms （59 aneurysms）， including 6 cases of middle cerebral artery occlusion， 4 cases of arteriovenous malformations and 11 cases of suspected cerebrovascular diseases. The rotational DSA 3D reconstruction technology showed 61 cases of intracranial aneurysms including 2 cases of multiple aneurysms （65 aneurysms in total： 25 in intracervical and posterior communicating arteries， 6 in middle cerebral arteries， 23 in frontal and anterior communicating arteries， 7 in basilar arteries and 4 in vertebral arteries）， 8 cases of middle cerebral artery occlusion， 6 cases of arteriovenous malformations （3 cases of parietal cerebral arteriovenous malformations， 1 case of occipital cerebral arteriovenous malformations， 1 case of temporal lobe cerebral arteriovenous malformations， 1 case of cerebellar arteriovenous malformations）， 3 cases of moyamoya disease （clear abnormal blood vessels） and 2 cases of cavernous sinus fistula （clear fistula location and reflux veins）. The diagnosis positive rate （100%） of cerebrovascular diseases by rotational DSA 3D reconstruction was significantly higher than that of conventional DSA （91.25%） （χ2 =5.378，P ＜ 0.05）. For the relationship between the aneurysmal neck and the parent artery， the clear display rate of DSA 3D reconstruction （100%） was significantly higher than that of conventional DSA （49.15%） （χ2 =43.040，P＜ 0.05）. Conclusions Rotational DSA 3D reconstruction can visually and clearly display lesions in the brain， and provide more accurate and effective guidance for the identification and clinical diagnosis and treatment of cerebrovascular diseases.