Background　Acupuncture becomes one of the important auxiliary treatments for the rehabilitation of stroke patients.　Objective　This article reviews recent progress in mechanisms underlying the treatment of stroke with acupuncture.　Content　In stroke patients, acupuncture can significantly improve post-stroke depression(PSD), promote recovery from hemiplegia, reduce incidence of spasticity, and restores cognitive function. Additionally, acupuncture may help to prevent the reperfusion syndrome after carotid endarterectomy(CEA) and carotid artery stenting(CAS). Physiologically, acupuncture improves local microcirculation in ischemic region, reduces damage of oxygen-free radicals, controls inflammation, prevents formation of thrombosis, regulates several signal transduction pathways, and promotes reconstruction of collateral circulation. These physiological properties may contribute to the therapeutic benefits of acupuncture in stroke.　Trend　Acupuncture has evident therapeutic values in stroke: improving the functional recovery in various aspects. Further studies are required to elucidate the clinical benefits of acupuncture to brain ischemia patients receiving CEA or CAS.