Endothelial cell–pericyte interactions in ischemic stroke: From microvascular pathology to repair

Ischemic stroke (IS) is a major neurological disease that causes death and long-term disability worldwide. After ischemic injury, the brain undergoes complex pathological changes. As core components of the blood-brain barrier (BBB), endothelial cells and pericytes are crucial for maintaining barrier integrity, regulating cerebral blood flow, and mediating angiogenesis. Recent studies have demonstrated that, following IS, endothelial cells and pericytes can engage in mitochondrial transfer and exosome release through multiple pathways. This review constructs a signaling interaction network between endothelial cells and pericytes during IS, summarizing the cellular and molecular mechanisms underlying mitochondrial transfer networks and exosome-mediated communication. Furthermore, the physiological relevance of endothelial cell-pericyte interactions is discussed from the perspectives of vascular risk factors, non-coding RNAs, and cellular heterogeneity, as well as their potential therapeutic applications in the treatment of IS.