Mesenchymal stem cells (MSC) possess important biological characteristics of tissue repair and regeneration. MSC exert the properties promoting endogenous angiogenesis and have been widely applied in treatment of ischemia diseases. The therapeutic potency of MSC for ischemia diseases is owing to their secretion of angiogenic growth factors and release of exosomes. MSC promote angiogenesis stronger in hypoxia environment, and their miRNA played an important role in mediating regulation. This review summarizes recent advances in treatment of angiogenesis using MSC and their mechanisms. The angiogenic activities of MSC under hypoxia condition and their regulation by a miRNA network were discussed.