The presence of the endothelin isopeptides and endothelin receptors on neurons, glial cells and brain capillary endothelium suggests that endothelins may play a significant role in neuromodulation, astrocytic function and in regulation of cerebral blood flow. Furthermore, endothelins may play a significant role in the central regulation of neuroendocrine and autonomic nervous system functions (i.e., plasma volume, cardiovascular and respiratory control). Endothelin has potent cerebrovascular and proliferative effects suggesting a pathogenic role in cerebrovascular diseases. Endothelin receptors may represent important therapeutic targets for the treatment of both hemorrhagic and ischemic stroke. A review of the available data on endothelin levels and the effects of endothelin antagonists in cerebrovascular diseases is provided in the present report. Most notably is evidence in support of increased brain endothelin levels in hemorrhagic and ischemic stroke both in animal models and in humans. Also, endothelin receptor antagonists exert significant efficacy in animal models of cerebrovascular disease. For example, SB 209670, a rationally designed, potent, nonpeptide endothelin receptor antagonist, exerts therapeutic efficacy in reducing vasospasm following subarachnoid hemorrhage and neuroprotection following ischemic stroke. Certainly the available data warrants further evaluation of novel, selective endothelin receptor antagonists or endothelin converting enzyme inhibitors in cerebrovascular diseases.