In this review, the current role of intracranial angioplasty and intra-arterial vasodilators for post-hemorrhagic vasospasm is described with an emphasis on the rationale for its use and the supporting data from published scientific and clinical studies. Current clinical indications and specific techniques are highlighted. Special attention is given to the evolution of these techniques over time. A discussion of acute and chronic complications, short and long-term treatment results, device specific trends and controversies are outlined.