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AIMS This study aims to validate the potential of miR-93-3p, which is aberrantly expressed in acute ischemic stroke (AIS) patients, as a key biomarker for diagnosing AIS and predicting subsequent cognitive impairment. MATERIALS & METHODS The level of miR-93-3p was measured using quantitative real-time polymerase chain reaction (qRT-PCR). Receiver operating characteristic (ROC) curves were employed to assess the diagnostic value of miR-93-3p in AIS patients and its predictive value for post-stroke cognitive impairment (PSCI) risk after AIS. Additionally, SH-SY5Y cells subjected to oxygen-glucose deprivation (OGD) were used to explore how miR-93-3p regulates cell viability, inflammation, and oxidative stress. The target genes of miR-93-3p were predicted by integrating the TarBase, TargetScan, and miRDB databases, followed by GO and KEGG pathway enrichment analysis of the candidate genes. RESULTS miR-93-3p levels were higher in AIS patients, with a more pronounced increase in those with PSCI (p < 0.001). ROC curve analysis confirmed that miR-93-3p has strong diagnostic value for differentiating AIS patients from healthy controls. Moreover, miR-93-3p levels can independently predict PSCI occurrence. The levels of C-reactive protein and homocysteine were positively correlated with the level of miR-93-3p. In miR-93-3p-silenced SH-SY5Y cells, OGD-induced cell damage were reversed. The secretion of inflammatory factors and malondialdehyde (MDA) was reduced, while the intracellular levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) were increased. The predicted targets of miR-93-3p were significantly enriched in key pathways implicated in stroke pathophysiology, including ubiquitin-mediated proteolysis, cellular response to decreased oxygen levels, and the Notch signaling pathway. CONCLUSIONS In conclusion, miR-93-3p may serve as a biomarker for AIS diagnosis and PSCI prediction.