Abstract: Ischemic disease is one of the main causes of death or disability.Many clinical adverse events can lead to ischemic injury, such as myocardial infarction, ischemic stroke, solid organ transplantation and hemorrhagic shock.Mesenchymal stem cells have multidifferentiation potential, and the exosomes secreted by mesenchymal stem cells contain various therapeutic biological factors, which can promote regeneration, suppress apoptosis, and regulate immune response.The nanoscale size of exosomes enables them to target remote organs through blood circulation, and the membrane proteins on the surface of exosomes confer targeting ability that facilitates recovery from various organ or tissue damage.Based on the above advantages, stem cell exosomes have attracted extensive attention in the academic community.Research interest in the use of exosomes for ischemic tissue damage treatment has been growing in recent years.This article reviews the biogenesis mechanism and properties of exosomes derived from stem cells.Additionally, it reports the research progress in the use of stem cell exosomes for the treatment of ischemic diseases, and discusses the challenges in the clinical application of stem cell exosomes.