Lingling Tuo, Xinyun Li, Jiejin Zhao
The neuroimmune response following ischemic stroke is a highly dynamic and complex process with dualistic effects. Traditional broad-spectrum anti-inflammatory strategies are limited in efficacy and may impede repair due to a lack of spatiotemporal specificity. This review systematically proposes and argues for "spatiotemporally precise immune reprogramming" as the core paradigm for next-generation stroke neuroimmune therapy. It critically analyzes the necessity of shifting the paradigm from systemic "immunosuppression" to intralesional "precise reprogramming." The article further constructs a detailed technical roadmap to achieve this paradigm, encompassing key cellular and molecular targets, advanced delivery systems (such as targeted nanotechnology and biomaterial scaffolds), and the challenges of clinical translation. This review aims to provide a theoretical framework and future directions for developing novel therapeutic strategies that can dynamically modulate the immune microenvironment according to the pathological phase and cellular specificity of stroke to promote neural repair.