Gastric cancer is one of the most common malignant tumors worldwide and presents many treatment challenges, especially in relation to late-stage treatment and its high recurrence rate. Angiogenesis is a key process in the growth and metastasis of gastric cancer, and studies aimed at researching and developing antiangiogenesis therapies are therefore important for the treatment of gastric cancer. Exosomes are nanoscale vesicles released by cells, which serve as important messengers for intercellular communication. They regulate local and distant cell communication by transporting specific exosomes components, and it can also promote or inhibit the development and progression of gastric cancer by regulating the growth, proliferation, and angiogenesis of tumor cells. Exosomes transport bioactive molecules from donor cells to recipient cells, leading to reprogramming of target cells and cascade molecular reactions. This review summarizes the relationship between exosomes and tumor angiogenesis in gastric cancer, and the current research status of exosomes in anti-angiogenic therapy. The importance of the physiological structure and function of exosomes in gastric cancer angiogenesis indicates the potential importance of combining exosomes with anti-angiogenic therapy for the treatment of gastric cancer.