Stroke is the second leading cause of death and the third leading cause of disability worldwide. Most strokes are classified as ischemic, meaning they involve blockage of blood supply. There are no effective treatments for ischemic stroke or its complications, but several types of cells naturally produce molecules that can help heal ischemic tissue. These molecules are packaged and released within sacs called exosomes that can deliver them to other cells, making exosomes promising targets for stroke therapy. For example, some exosomes can exert anti-inflammatory effects, promote blood vessel formation, and support the development of new neurons. Beneficial exosomes can also suppress cell death and regulate immune responses. Studies on rat and rabbit stroke models have supported the clinical potential of exosomes to promote healing after stroke and a few clinical trials in humans are currently underway. Although more confirmation is needed, the evidence so far suggests that both natural and engineered exosomes can help treat stroke, providing hope for patients with stroke and post-stroke complications.