The minimally invasive approach to managing patients with ischemic and hemorrhagic stroke by endovascular intervention has made tremendous progress over the past years. Early recognition of stroke, improved ability to accurately diagnose the site of pathological abnormality with advanced imaging techniques and advances in treatment alternatives have led to better patient outcomes. Endovascular techniques for cerebral revascularization, a leading new therapeutic approach in the treatment of cerebrovascular disease, play a major role in both the management of acute stroke and secondary prevention. Selective intra-arterial thrombolysis for acute stroke has been performed for more than two decades with increasing success. Neurovascular therapies for secondary prevention include angioplasty of extracranial and intracranial vessels, as well as procedures for arterial reconstruction.