Conventional open repair of the aortic arch is associated with a higher risk of perioperative complications and mortality. Endovascular aortic arch repair (EAAR) offers a minimally invasive treatment option for patients deemed high risk for open surgery. However, compared to conventional open surgery, EAAR still carries an elevated risk of stroke. Branch TEVAR represent one of the most promising techniques for the endovascular treatment of aortic arch diseases. Although the early stroke risk is slightly higher than that of conventional open surgery, such risks are considered acceptable for high-risk patients. The primary causes of postoperative stroke include solid embolism, gas embolism, and cerebral hypoperfusion. Key strategies for preventing stroke following EAAR include preoperative assessment, perioperative monitoring, pharmacological prevention, and optimization of intraoperative procedures. For patients who have already developed a stroke, prompt diagnosis and assessment, pharmacological treatment, and appropriate surgical interventions form the cornerstone of treatment, and effective multidisciplinary collaboration is particularly crucial for improving the patient's condition and prognosis. Currently, there is still considerable research space in the prevention and treatment of stroke associated with EAAR. Therefore, the authors address the incidence, mechanisms, risk factors, as well as prevention and treatment strategies for early postoperative stroke following EAAR, to provide insights for clinical work.