Acute ischemic stroke (AIS) is a prevalent neurological disorder that can lead to severe disability. During its progression, neutrophils play multifaceted roles-they both drive inflammatory responses and contribute to neural tissue repair. This review comprehensively analyzes the characteristics of neutrophils, their functions in AIS, the dual impacts of inflammation, as well as existing and emerging therapeutic strategies. The aim is to enhance understanding of the pathological mechanisms underlying AIS, identify potential therapeutic targets, and provide scientific evidence for improving long-term patient outcomes.