Ischemic stroke （IS） is a neurological disorder with high rates of disability and mortality worldwide， characterized by complex interactions between immune-inflammatory responses and various forms of cell death during its onset and progression. In recent years， pyroptosis， a form of programmed cell death mediated by inflammasomes， has attracted increasing attention for its critical role in post-stroke neuronal injury. Among the underlying mechanisms， the NOD-like receptor family pyrin domain-containing 3 inflammasome-Gasdermin D （NLRP3-GSDMD） pathway， as the central signaling axis of pyroptosis， plays a crucial regulatory role in immune responses and neuronal dysfunction following cerebral ischemia. However， current therapeutic strategies targeting this pathway remain limited by insufficient specificity and an incomplete understanding of its mechanisms of action. Therefore， this review summarizes the immuno-inflammatory pathology of IS， the mechanisms of the NLRP3-GSDMD pathway and pyroptosis， as well as emerging immunotherapeutic strategies targeting this signaling axis， aiming to provide insights and references for future research on pyroptosis-based immunomodulatory therapies for stroke.