Advances in the mechanisms of electroacupuncture in the treatment of cerebral ischemia–reperfusion injury

Cerebral ischemia-reperfusion injury (CIRI) is a critical pathological process that adversely affects neurological recovery and prognosis after reperfusion therapies for ischemic stroke, and effective targeted interventions remain limited. Accumulating experimental and clinical evidence indicates that electroacupuncture (EA), as a traditional Chinese medicine-based intervention with controllable stimulation parameters, can attenuate CIRI and improve neurological outcomes to a certain extent. Current studies suggest that the neuroprotective effects of EA involve integrated modulation of multiple pathological processes, including neuronal apoptosis, inflammatory responses, oxidative stress, blood-brain barrier disruption, angiogenesis, and synaptic plasticity, exhibiting characteristics of multi-target, multi-pathway, and dynamic regulation. Meanwhile, EA stimulation parameters, acupoint selection, and intervention timing play important roles in determining therapeutic efficacy. Based on an overview of the major pathological mechanisms of CIRI, this review systematically summarizes the key molecular pathways and parameter-related features underlying EA intervention, aiming to provide references for mechanistic integration and clinical application of EA in CIRI.