Cerebrovascular diseases, characterized by high incidence, disability, and mortality rates, have emerged as a leading global cause of death and long-term disability. Organoid technology, a three-dimensional in vitro culture system derived from stem cells or tissue cells, enables the simulation of organ development, physiological processes, and pathological mechanisms, demonstrating significant potential in cerebrovascular disease research and therapeutic development. This review summarizes recent advances in organoid applications for cerebrovascular diseases, with a focus on strategies for constructing vascularized cerebral organoids, including in vivo transplantation, in vitro culture systems, and bioengineering approaches. Studies reveal that these models not only recapitulate neurovascular unit interactions but also serve as powerful platforms for drug screening and mechanistic investigations, offering novel therapeutic strategies for cerebrovascular disorders. Current challenges include insufficient vascularization efficiency and limited integration capacity with host tissues. Future integration of gene editing, microfluidic chips, and high-throughput 3D bioprinting technologies is expected to enhance the functionality and clinical translatability of vascularized cerebral organoids, thereby advancing personalized medicine and precision healthcare.