Efficacy of Acupuncture Combined with Local Anesthesia in Ischemic Stroke Patients with Carotid Artery Stenting: A Prospective Randomized Trial



To evaluate the efficacy of electro-acupuncture (EA) or transcutaneous electrical acupoint stimulation (TEAS) on perioperative cerebral blood flow (CBF) and neurological function in ischemic stroke (IS) patients undergoing carotid artery stenting (CAS).


In total, 124 consecutive IS patients were randomly allocated to the EA, TEAS, and sham groups (groups A, T, and S; 41, 42, and 41 cases, respectively) by software-derived random-number sequence. Groups A and T received EA and TEAS, respectively, at the Shuigou (GV 26) and Baihui (GV 20), Hegu (LI4) and Waiguan (TE 5) acupoints. Group S received sham EA. The stimulation was started from 30 min before surgery until the end of the operation. The primary outcome was the CBF at 30 min after surgery, which was measured by transcranial Doppler sonography. The secondary outcomes included hyperperfusion incidence and neurological function. National Institutes of Health Stroke Scale (NIHSS) and General Evaluation Scale (GES) scores were recorded at 1 week, 1 month, and 3 months postoperatively.


Mean CBF velocity at 30 min after surgery in groups A and T was much lower than that in Group S (P < 0.05); the incidence of hyperperfusion in Groups A and T was also lower than that in group S (P <0.05). Acupuncture was an independent factor associated with reduced incidence of hyperperfusion (OR=0.042; 95% CI: 0.002–0.785; =0.034). NIHSS and GES scores improved significantly at 1 week postoperatively in Groups A and T than in Group S (P < 0.05). Relative to Group S, groups A and T exhibited significantly lower incidences of moderate pain, as well as higher incidences of satisfaction with anesthesia, at 1 day postoperatively (P < 0.05).


EA or TEAS administered in combination with local anesthesia during CAS can inhibit transient increases in CBF, reduce the incidence of postoperative hyperperfusion, and improve neurological function. (Registration No. ChiCTR-IOR-15007447)

This is a preview of subscription content, log in to check access.


  1. 1.

    Prasad K. Pathophysiology and medical treatment of carotid artery stenosis. Int J Angiol 2015;24:158–172.

    PubMed  PubMed Central  Article  Google Scholar 

  2. 2.

    Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387:1723–1731.

    PubMed  Article  Google Scholar 

  3. 3.

    Jadhav AP, Bouslama M, Aghaebrahim A, Rebello LC, Starr MT, Haussen DC, et al. Monitored anesthesia care vs intubation for vertebrobasilar stroke endovascular therapy. JAMA Neurol 2017;74:704–709.

    PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Cao Q, Zhang J, Xu G. Hemodynamic changes and baroreflex sensitivity associated with carotid endarterectomy and carotid artery stenting. Interv Neurol 2015;3:13–21.

    PubMed  Article  Google Scholar 

  5. 5.

    Qian XL, Zhou X, You Y, Qian X, Shu S, Fang F, et al. Traditional Chinese acupuncture for poststroke depression: a single-blind double-simulated randomized controlled trial. J Altern Complement Med 2015;21:748–753.

    PubMed  Article  Google Scholar 

  6. 6.

    Li YX, Wang Y, Zhang HY, Wu P, Huang W. The effect of acupuncture on the motor function and white matter microstructure in ischemic stroke patients. Evid Based Complement Altern Med 2015;2015:164792.

    Google Scholar 

  7. 7.

    Lim SM, Yoo J, Lee E, Kim HJ, Shin S, Han G, et al. Acupuncture for spasticity after stroke: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Altern Med 2015;2015:870398.

    Google Scholar 

  8. 8.

    Lin ZC, Yang SL, Xie XH, Tao J, Chen LD. Central mechanism of acupuncture at Baihui for memory impairment after stroke: a resting-state functional magnetic resonance imaging study. Chin J Rehabil Theory Pract (Chin) 2015;21:184–188.

    Google Scholar 

  9. 9.

    El-Deeb AM, Ahmady MS. Effect of acupuncture on nausea and/or vomiting during and after cesarean section in comparison with ondansetron. Anesthesiology 2011;25:698–703.

    Google Scholar 

  10. 10.

    An LX, Chen X, Ren XJ, Wu HF. Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing a supratentorial craniotomy. Am J Chin Med 2014;42:1099–1109.

    PubMed  Article  Google Scholar 

  11. 11.

    Kaku YK, Iihara N, Nakajima H, Kataoka H, Fukuda K, Masuoka J, et al. Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab 2012;32:2066–2075.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Moulakakis K, Mylonas S, Sfyroeras G, Andrikopoulos V. Hyperperfusion syndrome after carotid revascularization. J Vasc Surg 2009;4:1060–1068.

    Article  Google Scholar 

  13. 13.

    Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infraction: a clinical examination scale. Stroke 1989;20:864–870.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Ohta T, Nakahara I, Matsumoto S, Ishibashi R, Miyata H, Nishi H, et al. Prediction of cerebral hyperperfusion after carotid artery stenting by cerebral angiography and single-photon emission computed tomography without acetazolamide challenge. Neurosurgery 2017;81:512–519.

    PubMed  Article  Google Scholar 

  15. 15.

    Maas MB, Kwolek CJ, Hirsch JA, Jaff MR, Rordorf GA. Clinical risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy. J Neurol Neurosurg Psychiatry 2013;84:569–572.

    PubMed  Article  Google Scholar 

  16. 16.

    Ratmansky M, Levy A, Messinger A, Birg A, Front L, Treger I. The effects of acupuncture on cerebral blood flow in post-stroke patients: a randomized controlled trial. J Altern Complement Med 2016;22:33–37.

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Li J, He JJ, Du YH, Cui J, Ma Y, Zhang X. Electroacupuncture improves cerebral blood flow and attenuates moderate ischemic injury via angiotensin II its receptors-mediated mechanism in rats. BMC Complement Altern Med 2014;14:441.

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Ascher E, Markevich N, Schutzer RW, Ma Y, Zhang X. Cerebral hyperperfusion syndrome after carotid endarterectomy: predictive factors and hemodynamic changes. J Vasc Surg 2003;37:769–777.

    PubMed  Article  Google Scholar 

  19. 19.

    Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, et al. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg 2007;107:1130–1136.

    PubMed  Article  Google Scholar 

  20. 20.

    Feng R, Zhang F. The neuroprotective effect of electroacupuncture against ischemic stroke in animal model: a review. Afr J Tradit Complement Altern Med 2014;11:25–29.

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Wang SH, Yang HL, Zhang J, Zhang B, Liu T, Gan L, et al. Efficacy and safety assessment of acupuncture and nimodipine to treat mild cognitive impairment after cerebral infarction: a randomized controlled trial. BMC Complement Altern Med 2016;16:361.

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Zhou F, Guo J, Cheng J, Wu G, Sun J, Xia Y. Electroacupuncture and brain protection against cerebral ischemia: specific effects of acupoints. Evid Based Complement Altern Med 2013;2013:804397.

    Google Scholar 

  23. 23.

    Xu H, Zhang YM. Effects of acupuncture at GV 20 and ST 36 on the expression of matrix metalloproteinase 2, aquaporin 4, and aquaporin 9 in rats subjected to cerebral ischemia/reperfusion injury. PLoS One 2014;9:e97488.

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Alexander DN, Cen S, Sullivan KJ, Bhavnani G, Ma X, Azen SP, et al. Effects of acupuncture treatment on poststroke motor recovery and physical function: a pilot study. Neurorehabil Neural Repair 2004;18:259–267.

    PubMed  Article  Google Scholar 

  25. 25.

    Hopwood V, Lewith GT. Does acupuncture help stroke patients become more independent? J Altern Complement Med 2005;11:175–177.

    PubMed  Article  Google Scholar 

Download references

Author information




Zhao CM and Xiong W prepared the manuscript and implemented anesthesia. Jia CR performed acupuncture manipulation. Xie SN assisted in data collection and performed statistical analyses. An LX designed the study, interpreted the data, and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Li-xin An.

Additional information

Conflict of Interest

The authors declare that they have no competing interests. The funding agent played no role in study design, data collection, or data analyses.

Supported by the Beijing Chinese Medicine Science and Technology Development Fund (No. JJ2014-04)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Xiong, W., Zhao, Cm., An, Lx. et al. Efficacy of Acupuncture Combined with Local Anesthesia in Ischemic Stroke Patients with Carotid Artery Stenting: A Prospective Randomized Trial. Chin. J. Integr. Med. 26, 609–616 (2020). https://doi.org/10.1007/s11655-019-3174-8

Download citation


  • electro-acupuncture
  • transcutaneous electrical acupoint stimulation
  • carotid artery stenting
  • cerebral blood flow
  • neurological function