Stroke is one of the most common causes of disability and death, and currently, ideal clinical treatment is lacking. Stem cell transplantation is a widely-used treatment approach for stroke. When compared with other types of stem cells, bone marrow mesenchymal stem cells (BMSCs) have been widely studied because of their many advantages. The paracrine effect is the primary mechanism for stem cells to play their role, and exosomes play an essential role in the paracrine effect. When compared with cell therapy, cell-free exosome therapy can prevent many risks and difficulties, and therefore, represents a promising and novel approach for treatment. In this study, we reviewed the research progress in the application of BMSCs-derived exosomes (BMSCs-exos) and BMSCs in the treatment of stroke. In addition, the advantages and disadvantages of cell therapy and cell-free exosome therapy were described, and the possible factors that hinder the introduction of these two treatments into the clinic were analyzed. Furthermore, we reviewed the current optimization methods of cell therapy and cell-free exosome therapy. Taken together, we hypothesize that cell-free exosome therapy will have excellent research prospects in the future, and therefore, it is worth further exploring. There are still some issues that need to be further addressed. For example, differences between the in vivo microenvironment and in vitro culture conditions will affect the paracrine effect of stem cells. Most importantly, we believe that more preclinical and clinical design studies are required to compare the efficacy of stem cells and exosomes.

中风是致残和死亡的最常见原因之一，目前缺乏理想的临床治疗方法。干细胞移植是中风的一种广泛使用的治疗方法。与其他类型的干细胞相比，骨髓间充质干细胞（BMSCs）具有许多优点，因此已得到广泛研究。旁分泌作用是干细胞发挥其作用的主要机制，而外泌体在旁分泌作用中起着至关重要的作用。与细胞疗法相比，无细胞外泌体疗法可以预防许多风险和困难，因此代表了一种有前途的新颖治疗方法。在这项研究中，我们综述了BMSCs外来体（BMSCs-exos）和BMSCs在中风治疗中的应用研究进展。此外，描述了细胞疗法和无细胞外泌体疗法的优缺点，并分析了阻碍这两种疗法进入临床的可能因素。此外，我们审查了细胞疗法和无细胞外泌体疗法的当前优化方法。综上所述，我们假设无细胞的外泌体治疗在未来将具有出色的研究前景，因此，值得进一步探索。还有一些问题需要进一步解决。例如，我们假设无细胞外泌体疗法在未来将有很好的研究前景，因此，值得进一步探索。还有一些问题需要进一步解决。例如，我们假设无细胞外泌体疗法在未来将有很好的研究前景，因此，值得进一步探索。还有一些问题需要进一步解决。例如，体内微环境和体外培养条件会影响干细胞的旁分泌作用。最重要的是，我们认为需要更多的临床前和临床设计研究来比较干细胞和外泌体的功效。