MicroRNAs are tiny RNAs widely expressed in eukaryotic organisms, exhibiting differential expression in numerous diseases. MicroRNA-122 (miR-122) is a signaling molecule closely associated with neurological diseases and has been extensively studied in cerebrovascular diseases. This article provides a review of the role and mechanisms of miR-122 in cerebrovascular diseases, aiming to offer new research targets for cerebrovascular diseases and a theoretical basis for the development of related drugs.