Abstract: Objective To investigate the effect of electroacupuncture (EA) at acupoints on the incidence of postoperative acute stroke in patients undergoing endovascular treatment for intracranial aneurysms, and to provide evidence for optimizing perioperative management strategies in this population.Methods Patients who underwent endovascular treatment for intracranial aneurysms under general anesthesia at the First Affiliated Hospital of Nanjing Medical University between October 2023 and April 2024 were enrolled. According to the random number table method, the patients were divided to an electroacupuncture group (group EA, n=140) and a control group (group C group, n=140). In group EA, electroacupuncture was performed to promote cerebral circulation and unblock cerebral collaterals. The acupoints Baihui, bilateral Fengchi, Neiguan, and Hegu were selected. Before anesthesia induction, an SDZ-V electroacupuncture stimulator was applied with alternating dense-disperse waves at 2/100 Hz for continuous stimulation over 30 min. In group C, needles were fixed at the same acupoints, with no electrical stimulation. The primary outcome was the incidence of postoperative acute stroke. Secondary outcomes included intraoperative regional cerebral oxygen saturation; the incidence of intraoperative cerebral vasospasm and cerebral arterial dissection; intraoperative dosage of nimodipine and vasoactive agents; serum inflammatory cytokine levels at 24 h postoperatively, including interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α; and the incidence of postoperative headache, nausea/vomiting, and delirium.Results Compared with group C, group EA showed a significantly reduced overall incidence of postoperative acute stroke, with marked reductions in both ischemic stroke and silent stroke incidences (all P<0.05). In addition, group EA exhibited a lower incidence of intraoperative cerebral vasospasm, reduced use of nimodipine and vasoactive agents, a smaller increase in serum IL-6 and TNF-α levels at 24 h postoperatively, higher IL-10 levels, and lower incidences of headache, nausea/vomiting, and delirium within 7 days after surgery (all P<0.05). No statistically significant differences were observed in the remaining indicators (P>0.05).Conclusions Electroacupuncture at acupoints effectively reduces the incidence of postoperative acute stroke in patients undergoing endovascular treatment for intracranial aneurysms, which is beneficial to enhance therapeutic efficacy and improve postoperative prognosis.