<p>Central nervous system ischemia–reperfusion injury, including cerebral ischemia reperfusion injury (CIRI) and spinal cord ischemia reperfusion injury (SCIRI), poses significant challenges in neurology. This condition is characterized by severe tissue damage following the restoration of blood flow after an ischemic event. Current therapeutic strategies primarily focus on re-establishing perfusion but often fail to address the secondary injuries induced by reperfusion, underscoring the need for innovative treatment. Extracellular vesicles (EVs) facilitate intercellular communication by transferring proteins, lipids, and nucleic acids, thereby influencing cellular pathways. This review examines the potential of EVs as a promising therapeutic strategy for central nervous system I/R injury. Growing evidence suggests that EVs can mitigate pathological mechanisms in both CIRI and SCIRI. Preclinical studies demonstrate that EVs derived from stem cells, astrocytes, and immune cells have shown potential in reducing damage and promoting recovery. Despite encouraging preclinical outcomes, the clinical translation of EV-based therapies faces several challenges, including standardization of EV production, optimization of delivery methods, and comprehensive evaluation of their safety and efficacy. Future research should prioritize elucidating the molecular mechanisms of EV action, refining production and delivery systems, and conducting clinical trials to assess the long-term therapeutic effects.</p>