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Traditionally viewed as a classic sentinel of innate immunity, Toll-like receptor 4 (TLR4) has emerged as a crucial pathological driver within the vascular endothelium, with its identity dictated by cell-type specificity, microenvironmental context, and fluctuating expression levels. This review critically examines the dual functional nature of endothelial TLR4, delineating how it transitions into a primary driver of vascular aging and organ-specific vascular pathologies. The profound spatial,...