The rapid and precise perfusion assessment of acute ischemic stroke is of paramount significance for treatment guidance and prognosis evaluation. With the continuous progress of imaging technologies, multi-delay pseudocontinuous arterial spin labeling (md-ASL), a non-invasive and radiation-free perfusion imaging technique, has increasingly drawn attention. This technique can provide key parameters such as cerebral blood flow (CBF) and arterial transit time (ATT), which helps to identify the ischemic penumbra and predict the evolution of lesions. However, although numerous studies have investigated the application of md-ASL in acute ischemic stroke (AIS), problems such as insufficient parameter standardization and limited clinical applicability still remain. Therefore, this paper aims to comprehensively summarize the latest research findings on md-ASL in the field of perfusion assessment for acute ischemic stroke, and conduct an in-depth analysis of the relationships between CBF and ATT parameters, the core and penumbra regions of the ischemic area, and clinical outcomes. Meanwhile, the paper explores the clinical application value of md-ASL under various recanalization conditions and its future development trends.