This systematic review analyzes the efficacy and safety of Mildronate in patients who have suffered an ischemic stroke (IS). The study involved a search for and analysis of scientific publications from 2000 to 2025, conducted in accordance with the PRISMA guidelines. The final selection included 11 studies, which demonstrated the positive effects of Mildronate on the recovery of neurological deficits, cognitive functions (including speech), and cerebral perfusion parameters. Metabolic correction achieved with Mildronate therapy was associated with improved biochemical markers, reduced oxidative stress, and increased levels of neurotrophic factors. Mildronate demonstrated a good safety profile and can be considered a promising adjunctive therapy for IS.