Cerebrovascular dysfunction serves as a critical pathological basis for cerebrovascular diseases, characterized by high disability and mortality rates. Astrocyte-derived extracellular vesicle (AC-EV), which mediate intercellular communication by transporting bioactive substances such as proteins and nucleic acids, play a pivotal role in regulating cerebrovascular function under both physiological and pathological conditions. Recent studies have revealed that AC-EV not only participate in cerebrovascular homeostasis but also exhibit altered composition and function closely linked to the pathogenesis and progression of multiple cerebrovascular disorders, including stroke, Alzheimer's disease, and Parkinson's disease. As a result, they have emerged as promising diagnostic and therapeutic targets. This review systematically summarizes the mechanisms by which AC-EV regulate cerebrovascular function and explores their clinical prospects in disease diagnosis and treatment, aiming to provide a theoretical foundation for developing precise intervention strategies against cerebrovascular dysfunction.