Endothelial exocytosis of granules is a rapid response to vascular injury. However, the molecular machinery that regulates exocytosis in endothelial cells is not well understood. Recently developed techniques have defined the endothelial proteins that control vesicle and granule trafficking in endothelial cells. These techniques have revealed that syntaxin 4, synaptobrevin 3, and N-ethylmaleimide-sensitive factor (NSF) play a critical role in endothelial granule exocytosis. Additional studies have shown that nitric oxide regulates exocytosis by chemically modifying NSF. Further characterization of the factors that regulate exocytosis will lead to novel treatments for vascular diseases such as myocardial infarction and stroke.