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Ischemic stroke is a destructive vascular disease that carries the risk of high mortality, disability, and eventually the development of full-blown dementia. Despite the continuous development of new prognostic methods, the prediction of ischemic sequelae and early and late prognosis of stroke is still much easier said than to apply in practice. Cell-to-cell communication between neuronal, glial, and vascular cells are essential for normal functioning of the brain, and in cerebral ischemia, this communication is interrupted. New research has demonstrated the important role of exosomes in cell-to-cell communication via microRNA transfer, playing an integral role in multicellular crosstalk. Following a stroke, harmful and/or beneficial microRNAs are released into the circulation, significantly affecting the severity and prognosis of a stroke. This chapter provides an overview of the current literature on the possible harmful and beneficial roles of cargo derived from exosomes in ischemic stroke. A snapshot of experimental evidence for the role of exosome-derived microRNAs in ischemic stroke followed by clinical studies exploring the diagnostic and prognostic potential of exosomes in stroke patients are presented. Finally, the promises and pitfalls along with future directions are discussed.
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