Purpose <p>To compare differences in efficacy of endovascular vasospasm therapy (EVT) with pharmacological, mechanical or combined treatment.</p> Methods <p>In a single-center retrospective analysis, we included 60 patients with EVT after aneurysmal subarachnoid hemorrhage from 2017–2022. EVT treatment groups were: 1. Single or 2. dual vasodilator application, 3. transluminal balloon angioplasty (TBA) alone, with 4. single, or 5. dual vasodilator application, or 6. Stent-Retriever-Angioplasty alone, with 7. single, or 8. dual vasodilator application. Arterial diameters were measured on admission and after treatment. We compared relative increase and significant difference in diameter for each treatment group via multivariable linear regression (SPSS statistics). Age, sex, number of previous treatments and severity of spasm were included as confounding variables.</p> Results <p>In 628 treated vessel segments, dual vasodilator application showed significant difference restoring 4.4% more diameter than single vasodilator application alone (<i>p</i>—.015). TBA alone, with single or dual vasodilator application was most effective, restoring 28.4% more diameter than single vasodilator application alone (<i>p</i> &lt; .001). Stent-Retriever-Angioplasty was more effective with combined dual vasodilator application (<i>p</i> &lt; .001), not with single or no vasodilator combination. Adverse outcomes were recorded in 2.4% of interventions.</p> Conclusion <p>EVT effectiveness remains a key target in vasospasm rescue treatment but relies on the right treatment modality. TBA remains most effective in vessel dilation. Stent-Retriever-Angioplasty may present an alternative to just pharmacological treatment balancing accessibility and risk profile. Using a combination of vasodilators may enhance treatment efficacy but the combination of nimodipine and papaverine shows little effect in our study.</p> Graphical Abstract <p></p>