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The clinical efficacy of ischemic stroke is severely limited by the difficulty in targeted delivery of neuroprotective agents across the blood-brain barrier to the ischemic region. Liposomes, with their unique bilayer structure, can carry both hydrophilic and hydrophobic drugs and have excellent biocompatibility, modifiability, and high efficiency in crossing the blood-brain barrier, which have become a key strategy to break through the bottleneck of drug delivery in ischemic stroke treatment. This paper systematically reviews the structural properties of liposomes, their targeted delivery mechanisms, and their cutting-edge applications in ischemic stroke therapy in the past decade, focusing on the precise accumulation of neuroprotective agents in the ischemic region by surface-modified liposomes through the synergistic strategy of active/passive targeting, especially in piggybacking on the active ingredients of TCM. The paper analyzes in depth the latest advances of modified liposomes in inhibiting neuroinflammation, attenuating ischemia/reperfusion injury, combining with tissue plasminogen activator and biomimetic modification of delivery systems. It aims to provide a new theoretical framework for the precise and individualized treatment of ischemic stroke and to provide a reference for the development of neuroprotective agent delivery systems based on liposome technology.