Nanomedicines in ischemic cardiovascular and cerebrovascular diseases: Theranostic technologies based on reactive...

Ischemic cardiovascular and cerebrovascular diseases remain the leading causes of morbidity and mortality worldwide. Reactive oxygen species (ROS) act as central mediators of ischemia-induced injury, connecting mitochondrial dysfunction, calcium overload, inflammatory activation, endothelial damage, and maladaptive tissue remodeling. However, conventional antioxidant therapies have demonstrated limited clinical efficacy due to poor bioavailability, short circulation half-lives, insufficient lesion specificity, and systemic off-target effects. Consequently, ROS-responsive nanosystems have emerged as promising nanotheranostic platforms that exploit oxidative stress as both a diagnostic cue and a therapeutic trigger for lesion-selective intervention. This review summarizes the sources and pathophysiological roles of ROS in ischemic heart and brain injury, and critically examines recent advances in ROS-guided nanodiagnostics and nanotherapeutics across major ischemic cardiovascular and cerebrovascular conditions. Diagnostic progress is discussed in relation to direct redox-activatable probes, ROS-associated surrogate probes, and multimodal or self-reporting platforms across major imaging modalities. Therapeutic applications are reviewed in the context of atherosclerosis, myocardial ischemia-reperfusion injury, heart failure progression, ischemic stroke, and thrombotic disease, with an emphasis on catalytic ROS scavenging, ROS-triggered local drug release, and targeted theranostic nanoplatforms for lesion-selective intervention. Key translational priorities include oxidant specificity, quantitative validation, biosafety, scalable manufacturing, control of in vivo biological identity, and clinically actionable endpoints aligned with disease stage and treatment timing.