Stroke is a major cerebrovascular disease with high mortality and disability rates that seriously threaten human health. Conventional pharmacotherapy serves as the main treatment for stroke. Nevertheless, restricted by the blood brain barrier (BBB) and other obstacles, drugs fail to achieve satisfactory targeted efficacy and biosafety, leaving much room for improvement. With the rapid development of nanomedicine, nanomaterials have been widely adopted in various medical fields, offering novel research avenues for stroke diagnosis and treatment. Benefiting from unique properties including nanoscale size effects, nanomaterials can elevate the resolution and sensitivity of imaging modalities for early lesion identification, and cross the BBB to boost the efficiency of targeted drug delivery. At present, the clinical translation of nanomaterials is hampered by multiple challenges such as biosafety risks and standardized quality control. Along with sustained advances in fundamental research and manufacturing technology, nanomaterial-based platforms are expected to address current bottlenecks and emerge as critical therapeutic tools for cerebrovascular disorders. This review recapitulates cutting-edge research progress of nanomaterials in stroke theranostics, analyzes translational barriers and prospective development trends, and intends to provide references for further investigation and clinical transformation of innovative nano-theranostic strategies against stroke.