Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Launching: Thursday 12th December 2024
ADVANCED SEARCH
Log in
Top
Perioperative Medicine
Published in:

Open Access 01-12-2024 | Acupuncture | Research

The benefit of early acupuncture within 7 days for neurological outcomes in ischemic stroke patients after cardiac surgery

Authors: Chia-Hsuan Kuan, Chi-Nan Tseng, Tse-Hung Huang, Chien-Chung Yang, Yu-Sheng Chen

Published in: Perioperative Medicine | Issue 1/2024

Login to get access

Abstract

Background

Stroke is a critical complication of cardiac surgery that results in increased mortality and morbidity. Limited treatment options are available for patients with severe neurological deficits, such as impaired consciousness. Acupuncture is a well-known integrative management method for stroke patients. However, there are no extensive reports discussing the benefit of acupuncture in stroke patients after cardiac surgery. The aim of this study was to demonstrate the role of acupuncture in the neurological recovery of these patients and to identify the factors that provide greater benefit.

Methods

This self-controlled case series utilized inpatient data from stroke patients after cardiac surgery who received acupuncture in a single center from 2013 to 2019. The primary outcomes included the Glasgow Coma Scale, muscle strength grading scale, and Barthel Index. Wilcoxon signed-rank test was used to compare the neurological differences between pre-acupuncture and post-acupuncture.

Results

Fifty-one patients who met the criteria showed significant improvement of the severity of neurological impairment, including the Glasgow Coma Scale, muscle strength grading scale, and Barthel Index (p < 0.05). The group that underwent aortic dissection repair and the group that started acupuncture within 7 days after stroke showed greater improvement (p < 0.01). No adverse events were reported. Three patients with profound neurological impairment who received acupuncture intervention were described.

Conclusions

Acupuncture has a potential benefit in improving neurological impairment and reducing mortality in stroke patients after cardiac surgery, especially within 7 days of the event. Further larger prospective studies with control groups are needed to provide convincing evidence.
Literature
Akowuah EF, Maier RH, Hancock HC, Kharatikoopaei E, Vale L, Fernandez-Garcia C, et al. Minithoracotomy vs conventional sternotomy for mitral valve repair: a randomized clinical trial. JAMA. 2023;329(22):1957–66.PubMedPubMedCentralCrossRef
Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091–6.PubMedCrossRef
Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017;12(5):444–50.PubMedCrossRef
Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type A aortic dissection. Circulation. 2013;128(11 Suppl 1):S175–9.PubMed
Buszman PE, Buszman PP, Banasiewicz-Szkróbka I, Milewski KP, Żurakowski A, Orlik B, et al. Left main stenting in comparison with surgical revascularization: 10-year outcomes of the (left main coronary artery stenting) LE MANS trial. JACC Cardiovasc Interv. 2016;9(4):318–27.PubMedCrossRef
Chavez LM, Huang SS, MacDonald I, Lin JG, Lee YC, Chen YH. Mechanisms of acupuncture therapy in ischemic stroke rehabilitation: a literature review of basic studies. Int J Mol Sci. 2017;18(11):2270.PubMedPubMedCentralCrossRef
Costantini E, Carlin M, Porta M, Brizzi MF. Type 2 diabetes mellitus and sepsis: state of the art, certainties and missing evidence. Acta Diabetol. 2021;58(9):1139–51.PubMedPubMedCentralCrossRef
De Freitas S, Rossi MJ, Abramowitz SD, Fatima J, Kiguchi MM, Vallabhaneni R, et al. Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. J Vasc Surg. 2021;74(5):1721-1731.e4.PubMedCrossRef
Dumfarth J, Kofler M, Stastny L, Plaikner M, Krapf C, Semsroth S, et al. Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery. Eur J Cardiothorac Surg. 2018;53(5):1013–20.PubMedCrossRef
Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63(10):1606–10.PubMedCrossRef
Fan M, Zhang B, Chen C, Li R, Gao W. Evidence quality assessment of acupuncture intervention for stroke hemiplegia: an overview of systematic reviews and meta-analyses. Front Neurol. 2024;15:1375880.PubMedPubMedCentralCrossRef
Fichadiya A, Menon BK, Gregory AJ, Teleg E, Appoo JJ. Neuroanatomy and severity of stroke in patients with type A aortic dissection. J Card Surg. 2022;37(2):339–47.PubMedCrossRef
Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31.PubMedCrossRef
Hatfield SA, Nores MA, James TM, Rothenberg M, Kapila A, Cubeddu RJ, et al. Predictors and outcomes of stroke after transcatheter aortic valve replacement. J Card Surg. 2020;35(1):21–7.PubMedCrossRef
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895–1032.PubMed
Holm NR, Mäkikallio T, Lindsay MM, Spence MS, Erglis A, Menown IBA, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2020;395(10219):191–9.PubMedCrossRef
Hseuh TP, Hung YC, Hu WL. Impact of acupuncture therapy in postoperative aortic dissection patients with cerebral infarction: a case study. Chin J Integr Med. 2017;23(1):76–9.CrossRef
Huang Z, Chen Y, Xiao Q, Kuang W, Liu K, Jiang Y, et al. Effect of acupuncture for disorders of consciousness in patients with stroke: A systematic review and meta-analysis. Front Neurol. 2022;13:930546.PubMedPubMedCentralCrossRef
Karunanantham J, Ali JM, Evans NR, Webb S, Large SR. Impact of stroke on outcomes following cardiac surgery: propensity matched analysis. J Card Surg. 2020;35(11):3010–6.PubMedCrossRef
Kashani HH, Mosienko L, Grocott BB, Glezerson BA, Grocott HP. Postcardiac surgery acute stroke therapies: a systematic review. J Cardiothorac Vasc Anesth. 2020;34(9):2349–54.PubMedCrossRef
Knol WG, Budde RPJ, Mahtab EAF, Bekkers JA, Bogers AJJC. Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to prevent embolic stroke. Eur J Cardiothorac Surg. 2021;60(6):1259–67.PubMedPubMedCentralCrossRef
Kumar N, Ramphul K, Bawna F, Paray NB, Dulay MS, Dhaliwal JS, et al. Trends in mortality among the geriatric population undergoing Surgical aortic valve replacement (SAVR) and potential racial disparities: a 20-year perspective via the National (Nationwide) Inpatient Sample. J Geriatr Cardiol. 2024;21(7):716–22.PubMedPubMedCentralCrossRef
Li QX, Zhao XJ, Fan HY, Li XN, Wang DL, Wang XJ, et al. Application values of six scoring systems in the prognosis of stroke patients. Front Neurol. 2019;10:1416.PubMedCrossRef
Liu CH, Hsieh YT, Tseng HP, Lin HC, Lin CL, Wu TY, et al. Acupuncture for a first episode of acute ischaemic stroke: an observer-blinded randomised controlled pilot study. Acupunct Med. 2016;34(5):349–55.PubMedCrossRef
Liu F, Tsang RC, Zhou J, Zhou M, Zha F, Long J, et al. Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients. J Stroke Cerebrovasc Dis. 2020;29(9):105033.PubMedCrossRef
Ng HP, Huang CM, Ho WC, Lee YC. Acupuncture differentially affects the high-frequency spectral energy in radial pulse positions depending on type of lower back pain. Evid Based Complement Alternat Med. 2019;2019:4024501.PubMedPubMedCentralCrossRef
Obel LM, Lindholt JS, Lasota AN, Jensen HK, Benhassen LL, Mørkved AL, et al. Clinical characteristics, incidences, and mortality rates for type A and B aortic dissections: a nationwide Danish population-based cohort study from 1996 to 2016. Circulation. 2022;146(25):1903–17.PubMedCrossRef
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72–227.PubMed
Patsouras A, Farmaki P, Garmpi A, Damaskos C, Garmpis N, Mantas D, et al. Screening and risk assessment of coronary artery disease in patients with type 2 diabetes: an updated review. In Vivo. 2019;33(4):1039–49.PubMedPubMedCentralCrossRef
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418.PubMedCrossRef
Roy P, Brahme I, Reddy RP, Wechsler L, Gleason T, Thirumala PD. Meta-analysis of perioperative stroke and mortality in CABG patients with carotid stenosis. Neurologist. 2020;25(5):113–6.PubMedCrossRef
Sato S, Toyoda K, Uehara T, Toratani N, Yokota C, Moriwaki H, et al. Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes. Neurology. 2008;70(24 Pt 2):2371–7.PubMedCrossRef
Scolletta S, Taccone FS, Donadello K. Brain injury after cardiac surgery. Minerva Anestesiol. 2015;81(6):662–77.PubMed
Sheu SY, Yao CH, Fu YT, Wang WL. Acupuncture as complementary therapy for hypoxic encephalopathy: a case study. Complement Ther Med. 2010;18(6):265–8.PubMedCrossRef
Stolz L, Cheung A, Boone R, Fam N, Ong G, Villablanca P, et al. Transjugular transcatheter tricuspid valve replacement: early compassionate use outcomes. JACC Cardiovasc Interv. 2024;17(16):1936–45.PubMedCrossRef
Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice MC, Puskas J, et al. Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med. 2019;381(19):1820–30.PubMedCrossRef
Sultan I, Bianco V, Kilic A, Jovin T, Jadhav A, Jankowitz B, et al. Predictors and outcomes of ischemic stroke after cardiac surgery. Ann Thorac Surg. 2020;110(2):448–56.PubMedCrossRef
Tan L, Zeng L, Wang N, Deng M, Chen Y, Ma T, et al. Acupuncture to promote recovery of disorder of consciousness after traumatic brain injury: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:5190515.PubMedPubMedCentralCrossRef
Tarakji KG, Sabik JF 3rd, Bhudia SK, Batizy LH, Blackstone EH. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011;305(4):381–90.PubMedCrossRef
Wang J, Tian L, Zhang Z, Yuan B, Zhang T, Li X, et al. Scalp-acupuncture for patients with hemiplegic paralysis of acute ischaemic stroke: a randomized controlled clinical trial. J Tradit Chin Med. 2020;40(5):845–54.PubMed
Wang L, Chi X, Lyu J, Xu Z, Fu G, Liu Y, et al. An overview of the evidence to guide decision-making in acupuncture therapies for early recovery after acute ischemic stroke. Front Neurol. 2022;13:1005819.PubMedPubMedCentralCrossRef
Wei YC, Sun MF, Chang KC, Chang CJ, Hung YC, Lin YJ, et al. Pilot scheme of health policy in stroke adjuvant acupuncture therapy for acute and subacute ischemic stroke in Taiwan. Evid Based Complement Alternat Med. 2011;2011:689813.PubMedPubMedCentralCrossRef
Wu Y, Zhao K, Wen W, Zhu K, Lu F, Kong Y, et al. Acupuncture for poststroke coma: a systematic review and meta-analysis. Complement Ther Med. 2024;82:103046.PubMedCrossRef
Xu Y, Xie X, Su P, Wang J, Luo X, Niu J, et al. Effectiveness of acupuncture in the governor vessel and Yangming meridian for the treatment of acute ischemic stroke: a systematic review and network meta-analysis. PLoS ONE. 2024;19(4):e0300242.PubMedPubMedCentralCrossRef
Yamamoto K, Natsuaki M, Morimoto T, Shiomi H, Matsumura-Nakano Y, Nakatsuma K, et al. Periprocedural stroke after coronary revascularization (from the CREDO-Kyoto PCI/CABG Registry Cohort-3). Am J Cardiol. 2021;142:35–43.PubMedCrossRef
Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ. Acupuncture for stroke rehabilitation. Cochrane Database Syst Rev. 2016;2016(8):Cd004131.PubMedPubMedCentral
Yeh BY, Chen YL, Chang SA, Lee CS, Chen YS. Acupuncture helps to regain the consciousness of a COVID-19 patient complicated with hypoxic-ischemic encephalopathy: a case report. Neurol Sci. 2021;42(2):475–8.PubMedPubMedCentralCrossRef
Zhang P, Jiang G, Wang Q, Wang Y, Ma Y, Li S, et al. Effects of early acupuncture combined with rehabilitation training on limb function and nerve injury rehabilitation in elderly patients with stroke: based on a retrospective cohort study. Biomed Res Int. 2022;2022:8557936.PubMedPubMedCentral
Zhang SH, Liu M, Asplund K, Li L. Acupuncture for acute stroke. Cochrane Database Syst Rev. 2005;2005(2):CD003317.
Zhong X, Luo X, Li L, Liu J, Sun X, Zhang H. Effects of acupuncture on ischemic stroke: a systematic review with meta-analyses and trial sequential analyses. Complement Ther Clin Pract. 2024;57:101905.PubMedCrossRef
Zhuo Y, Xu M, Deng S, Zhang Y, Lu X, Wu B, et al. Efficacy and safety of dissimilar acupuncture intervention time-points in treating stroke: a systematic review and network meta-analysis. Ann Palliat Med. 2021;10(10):10196–212.PubMedCrossRef
Metadata
Title
The benefit of early acupuncture within 7 days for neurological outcomes in ischemic stroke patients after cardiac surgery
Authors
Chia-Hsuan Kuan
Chi-Nan Tseng
Tse-Hung Huang
Chien-Chung Yang
Yu-Sheng Chen
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Perioperative Medicine / Issue 1/2024
Electronic ISSN: 2047-0525
DOI
https://doi.org/10.1186/s13741-024-00470-z

Other articles of this Issue 1/2024

Prehabilitation of surgical patients: a bibliometric analysis from 2005 to 2023

  • Open Access
  • Review

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study

  • Open Access
  • Research

The association of the perioperative fluid balance and cardiopulmonary complications in emergency gastrointestinal surgery: exploration of a randomized trial

  • Open Access
  • Research

Opioid administration across racial and ethnic groups for patients undergoing liver resection: are there disparities?

Nomogram for predicting the risk of postoperative delirium in elderly patients undergoing orthopedic surgery

Unplanned hospital admissions within 24 h after 53,185 surgical procedures at a U.S. ambulatory surgery center