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Mounting evidence reframes stroke not as a single cerebral event but as a dynamic brain-body network disorder. Extracellular vesicles (EVs)-lipid bilayer-enclosed particles released by virtually all cells-serve as intercellular messengers that couple vascular injury, neuroinflammation, and systemic responses. EVs carry nucleic acids, proteins, and lipids reflective of their cellular sources and may reach the circulation and interface with the CNS via context-dependent routes, including blood-brain barrier (BBB) disruption and active transport mechanisms. This review integrates clinical and experimental evidence across vascular etiologies, intra-CNS communication, and systemic complications to outline how EV programs may encode and propagate stroke pathology. We further discuss emerging analytical standards, current clinical EV signatures, and translational frameworks-including how to distinguish stroke-specific signals from injury-generic responses-and outline trial designs to test whether modulating EV pathways can influence recovery trajectories.