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OBJECTIVE: To evaluate the effectiveness and safety of the Xingnao Kaiqiao needling method for treating acute ischemic stroke. DATA SOURCES: We retrieved relevant randomized controlled trials involving Xingnao Kaiqiao acu-puncture for treatment of acute ischemic stroke. The China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and PubMed were searched from June 2006 to March 2016. DATA SELECTION: We analyzed randomized and semi-randomized clinical controlled trials that com-pared Xingnao Kaiqiao acupuncture with various control treatments, such as conventional drugs or other acupuncture therapies, for treatment of acute ischemic stroke. The quality of articles was evaluated accord-ing to the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1), and the study was carried out using Cochrane system assessment methods. RevMan 5.2 was used for the meta-analysis of the included studies. OUTCOME MEASURES: The mortality rate, disability rate, activities of daily living (Barthel Index), and clinical efficacy were observed. RESULTS: Twelve studies met the inclusion criteria for this review. The meta-analysis showed that between Xingnao Kaiqiao acupuncture and the control treatment, Xingnao Kaiqiao acupuncture reduced the disabil-ity rate [risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.27–0.98, z = 2.03, P < 0.05], elevated the activities of daily living (weighted mean difference = 12.23, 95% CI: 3.66–20.08, z = 2.80, P < 0.005), and had greater clinical efficacy (RR = 1.61, 95% CI: 1.23–2.09, z = 3.53, P < 0.0004). However, there was no sig-nificant difference in mortality rate (RR = 0.61, 95% CI: 0.15–2.45, z = 0.70, P > 0.05). CONCLUSION: The Xingnao Kaiqiao needling method is effective and safe for acute ischemic stroke. However, there was selective bias in this study, and the likelihood of measurement bias is high. Thus, more high-quality randomized controlled trials are needed to provide reliable evidence of the efficacy and safety of Xingnao Kaiqiao acupuncture in the treatment of acute ischemic stroke.