Abstract: Small interfering RNA (siRNA) presents great potential in therapeutic application with distinct advantages including high efficiency of gene silencing, strong specificity, and wide range of targeting, however, its clinical application also faces challenges due to its poor cell membrane permeability and targeting efficiency. Extracellular vesicles, a kind of natural nanovesicles, have been proved to be excellent carriers for siRNA drug delivery. They can be used to protect siRNA from nuclease degradation, and enhance cellular uptake and cytoplasmic transport, demonstrating unique advantages in enhancing the biological activity and cell/organ selectivity of siRNA. This review highlights the strategies for extracellular vesicle-mediated siRNA delivery, and further discusses major considerations and future directions in this field, in order to provide some reference for the delivery and development of siRNA therapeutics.