Atherosclerosis is considered a systemic disease, and its presence in any site of the arterial system in the body raises suspicion of its presence somewhere else. Since atherothrombosis represents the most common cause of stroke, it is important to investigate whether coronary artery calcification, a commonly used measure of cardiac atherosclerotic burden, can be a similarly useful measure of atherosclerotic burden in the brain. This review aimed to summarize the current evidence regarding the role of CAC in the detection and prevention of cerebrovascular disease. CAC is an independent risk factor of stroke development, and using it to supplement traditional risk factors may allow better identification of higher-risk groups. Intermediate risk patients with elevated CAC scores can be started on statin therapy. CAC score may hold promise in identifying patient groups most likely to benefit from aspirin therapy. In addition, it may have a role in the identification of stroke patients who may benefit from closer cardiac monitoring as it can aid traditional scores in the detection of coronary pathology in stroke survivors.