The evolution of new neurointerventional techniques, along with improved imaging and catheter developments, has changed the interventional suite into a subspecialized operating room. This article discusses this operating room as a combination of neuroanesthesia, neuromonitoring, nursing, and technician support coordinated by the neruointerventionalist. The coordination of elective and emergent intervention is also discussed, from conception to completion of the plan, including arteriovenous emoblization, endovascular aneurysm obliteration, intra-arterial thrombolysis, extracranial and intracranial carotid angioplasty, and stenting. Specific examples are illustrated, including pharmacologic intervention complementing these techniques.