The supra-aortic branches are large arterial vessels that arise from the aortic arch and supply the head and upper extremities. These branches include the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery. There are several variations, with the most common being the bovine arch, where the left common carotid artery either shares a common trunk with the brachiocephalic trunk or arises directly from it. This variation is found in up to 20% of the population. Additionally, the left vertebral artery can arise directly from the aortic arch in up to 6% of individuals, and the right subclavian artery can arise as the last branch from the aortic arch, a condition known as an aberrant right subclavian artery or arteria lusoria, occurring in about 0.6% of the population. Atherosclerotic lesions in these large arteries are most common at their proximal segments, where they branch off from the aorta, and are more frequent in the left subclavian artery and the brachiocephalic trunk. This is due to the turbulence of arterial flow at these bifurcation points. Occlusive atherosclerotic disease of the supra-aortic branches is much less common than carotid bifurcation lesions, occurring in 0.5–6.4% of cases, and can involve single or multiple vessels. Other diseases affecting the supra-aortic branches, such as aneurysms, dissections, compressive syndromes of the upper thoracic cavity, and various types of vasculitis, are less common.