Recent technical developments and improvements in angiographic equipment, variable stiffness microcatheters, embolic materials, and better training increased efficacy, safety, and growing acceptance of endovascular procedures by various specialties. Additional treatment options, frequently supplementary to neurosurgical procedures can be offered to patients with intracranial vascular lesions, using existing vascular pathways and avoiding the need for surgical exposure. For endovascular embolization of unclippable aneurysms coils which are soft, retrievable, and thrombogenic appear a better alternative than detachable balloons. New understanding and capabilities in brain arteriovenous malformations (AVMs) as an adjunct to microsurgical resection, or as the sole form of treatment may improve results and long-term outcome. Experience with intravascular thrombolysis and balloon angioplasty of extracranial and intracranial vessels will potentially improve neurological deficits in cerebrovascular or vasospastic occlusive disease. Safety, efficacy, and long-term follow up are needed to maintain and improve standards of practice and offer new therapeutic alternatives.