Abstract Ischemic stroke is one of the leading causes of death and long-term neurological disability worldwide, characterized by high prevalence, frequent recurrence, and significant mortality. Despite recent advances, diagnostic and therapeutic options for this type of stroke especially in the acute phase and in ischemia/reperfusion (I/R) injury remain limited. Moreover, the vast majority of neuroprotective agents that have shown promising results in preclinical studies have failed in clinical trials. Exosomes, nanoscale extracellular vesicles secreted by nearly all cell types, have attracted considerable attention as effective mediators of intercellular communication within the central nervous system. Due to their ability to cross the blood–brain barrier (BBB), low toxicity and immunogenicity, and capacity to carry functional biomolecules including miRNAs, proteins, and lipids—exosomes play critical roles in the pathophysiological processes and post-stroke brain repair mechanisms. Recent studies have shown that exosomes may serve as non-invasive biomarkers for predicting injury severity and stroke prognosis, and they exhibit significant neuroprotective and regenerative effects in processes such as neurogenesis, angiogenesis, inflammation regulation, and apoptosis following cerebral I/R injury.
This review article explores the diagnostic and therapeutic potentials of exosomes in ischemic stroke and discusses the current challenges and future research prospects for translating this promising technology into clinical practice.