Atherosclerosis is a chronic inflammatory disease. The objective of the clinical use of anti-atherosclerotic drugs is to decrease circulating low density lipoprotein level, increase high density lipoprotein level, and reduce inflammation. However, the morbidity and mortality of cardiovascular disease remain high. Therefore, the identification of unknown therapeutic targets and the development of new anti-atherosclerotic drugs is growing. Exosome is a kind of membrane vesicles derived from late nuclear endosome (also known as polycystic body) secreted by living cells. Exosome contains protein, rRNA, and micro RNA, which are related to the source cells, and it can pass the biological barrier and produce various biological functions. Exosome is expected to become a novel drug delivery pathway and gene therapy vector for the treatment of atherosclerosis.