A retrospective review of conventional cerebral angiograms of 46 children with ischemic stroke was undertaken. Comparison was made with findings on magnetic resonance imaging and magnetic resonance angiography where available. Thirty-six children (78%) underwent magnetic resonance angiography in addition to conventional cerebral angiography. Seven patients had normal cerebral angiograms. Magnetic resonance angiography was diagnostic in 25 of 28 patients with large vessel occlusion, stenosis, or moya-moya syndrome. Conventional angiography was abnormal in four of nine patients with a normal magnetic resonance angiography. All patients with normal conventional angiograms also had normal magnetic resonance angiograms. Conventional angiography, either diagnostic or yielding further information, altered management in five patients with arterial dissection, one patient with large vessel occlusion, one patient with large vessel stenosis, and four patients with arteritis. On the basis of this experience, a clinical algorithm for the use of conventional cerebral angiography in the investigation of ischemic stroke in children is proposed.