Atherosclerosis (AS) is a chronic vascular inflammatory disease induced by multiple factors such as inflammation, lipid deposition, and aging, and serves as the pathological basis for diverse cardiovascular diseases. Extracellular vesicles (EVs) are membranous vesicles secreted by cells under pathological or physiological conditions, playing an essential role in intercellular communication. Extensive research has indicated that EVs affect the occurrence and development of AS by regulating vascular inflammation and extravascular matrix remodeling. This article reviews the role of EVs derived from various cell sources in the development of AS, as well as their application prospects in AS treatment.