Background <p>The superior cerebellar artery (SCA) may be involved in various intracranial vascular lesions, for which endovascular treatment (EVT) has been established as a therapeutic alternative to microsurgical approaches. Owing to SCA involvement, EVT for intracranial vascular lesions can be challenging.</p> Methods <p>Based on a systematic search of the PubMed database and incorporating clinical experience, this review summarizes the role of the SCA in EVT for intracranial vascular lesions.</p> Results <p>The SCA demonstrates several anatomical variants including origin fenestration, proximal arterial malformation formation, and persistent primitive trigeminal artery variation. During EVT for SCA aneurysms and dissections, preservation of the SCA is strongly recommended, and parent artery occlusion alone can be the final option. In patients with cerebellar arteriovenous malformations (AVMs), the SCA may serve as an effective transarterial approach to complete embolization, although flow-related SCA aneurysms necessitate pretreatment. For dural arteriovenous fistulas with SCA dural branch feeders, primary embolization of the dural feeder can prevent hemorrhagic complications. Selected cases of acute SCA occlusion may benefit from SCA recanalization. SCA aneurysms and AVMs may cause trigeminal neuralgia, with EVT offering potential pain relief in appropriate cases. In moyamoya disease, the SCA occasionally provides anterior circulation collateral supply.</p> Conclusion <p>The SCA has multiple roles in EVT for intracranial vascular lesions.</p>