Ischemic stroke (IS) is a common cerebrovascular accident that has garnered widespread attention due to its high rates of disability and mortality. Gut microbiota-derived extracellular vesicles (GMEVs), as a novel type of biological nanomaterial, can regulate various physiological processes in host cells by delivering bioactive substances and mediating membrane component-dependent physical interactions, demonstrating significant application value in the field of biomedicine. This review integrates relevant randomized controlled trials and mechanistic studies from both domestic and international research in recent years, firstly summarizing the evidence linking gut microbiota to IS, and then thoroughly exploring the potential mechanisms and engineering strategies of GMEVs in IS treatment. Finally, the article prospects the future directions for GMEVs in the precise intervention of IS. This review aims to provide a new perspective for understanding the role of the gut-brain axis in IS and to lay a theoretical foundation for the development of neuroprotective or reparative strategies based on GMEVs.