The gut microbiome is the largest microbial reservoir in the human body and plays a significant role in neural development, aging, and brain diseases. In recent years, the relationship between gut microbiota and ischemic stroke has become a hot research topic among stroke researchers. Under normal circumstances, the gut microbiota maintains a balanced state with the human body and the external environment. However, in high-altitude regions, hypoxia may lead to digestive dysfunction, causing bacterial translocation and imbalance of the gut microbiota. This article provides an overview of the correlation between atherosclerotic ischemic stroke and plateau gut microbiota and looks forward to its therapeutic prospects.