Objective To explore the experience of perceived control over illness in patients with ischemic stroke, and to provide references for the development of targeted intervention programs. Methods Using a phenomenological research method, 17 patients with ischemic stroke were selected for semi-structured interviews, and the data were analyzed with Colaizzi′s seven-step analytical approach.Results Three themes and ten sub-themes were extracted:pressure and challenges (psychological resource depletion, self-management burden, reduced well-being, and lack of supportive resources); coping and control (following professional guidance, fatalistic mentality, autonomous health management); needs and expectations (thirst for cognitive improvement, demands for emotional support, and reshaping of health behaviors). Conclusion Patients with ischemic stroke face challenges and needs in the process of perceived control over illness. Medical staff should adopt diversified, continuous, and targeted support strategies, optimize the social support system with the help of digital intelligent platforms, meet patients′ multi-dimensional needs, and improve their level of perceived control.