Exosomes (Exo) are small vesicles secreted by various cells and encapsulated by lipid bilayer membranes, which are widely involved in intercellular information communication, and can carry diverse bioactive molecules derived from donor cells, especially microRNA (miRNA). In recent years, the functions and potential mechanisms of exosomal miRNAs in the occurrence and development of atherosclerosis (As) have received extensive attention and in-depth study. This review summarizes the roles of exosomal miRNAs in As, focusing on their cellular sources and regulatory effects on the function of recipient cells. Meanwhile, this review also discusses their potential application value and prospect in the diagnosis and therapy of As.