Endovascular neurosurgery has evolved dramatically since the first description of aneurysm coiling in 1991 and is now employed as a primary treatment strategy for managing a multitude of cerebrovascular pathologies, including aneurysms, arteriovenous malformations (AVMs), and acute ischemic stroke. The endovascular approach offers an attractive, minimally invasive alternative for aneurysm treatment with low procedure-related morbidity and mortality. The durability and long-term efficacy of endovascular interventions is continuously evolving, especially with the introduction of newer coils, stents, and flow-diversion techniques. Endovascular management of AVMs can be used for presurgical embolization, preradiosurgical intervention, or palliative embolization or as a primary treatment for curative embolization, depending on the characteristics of the lesion. Advances in endovascular management of acute stroke have further increased the therapeutic window of recombinant tissue plasminogen activator administration using the intraarterial route and have led to the introduction of new devices for clot removal and vessel recanalization.