BACKGROUND: Acupuncture may be useful to treat the various clusters of symptoms occurring after a stroke. The use of evidence to underpin clinical practice and treatment guidelines (CPGs and TGs respectively) varies from country to country and may affect what recommendations are made by guideline developers. PURPOSE: To examine the extent to which international clinical and treatment guidelines on post-stroke treatment mention the role of acupuncture and to identify what symptoms they recommend for its use. METHOD: Scoping of national and international websites of CPGs and TGs r on the after care and rehabilitation of stroke patients provided by professional and government organisations was conducted. The presence/absence of recommendations and the underpinning evidence was appraised for the use of acupuncture for symptoms following stroke. RESULTS: Of 84 CPGs and TGs on post stroke after-care identified from 27 countries between 2001 and 2021, 49 made statements about acupuncture. Positive recommendations on the use of acupuncture were identified for 15 symptom areas from 11 countries for: stroke rehabilitation, dysphagia, shoulder pain, motor recovery, walking, balance, spasticity, upper limb extremity impairment, post-stroke pain, central post stroke pain, cognitive disorder, depression, and sleep problems. Thirty-five CPGs (2001-2018) from 18 countries published over the same period were identified that made no mention of acupuncture and therefore no recommendations were made on its use. CONCLUSIONS: Currently, evidence used by international guideline developers varies and this influences whether a positive or negative recommendation is made. Recommendations to use acupuncture should be based on the best available evidence which has been quality appraised.