OBJECTIVE: To evaluate the mediumto long-term efficacy of ligustrazine plus conventional medicine treating ischemic stroke. METHODS: Randomized controlled trials(RCTs) testing ligustrazine in the treatment of acute ischemic stroke were retrieved from Cochrane Library, PubMed, Excerpta Medica Database, Chinese Medical Journal Database, Chinese Biomedical Database, China National Knowledge Infrastructure Database, and Chinese Clinical Trial Register, and then identified by the inclusive and exclusive criteria. The quality of trials was assessed with the Cochrane Handbook 5.1, a risk of bias assessment tool. RevMan 5.1 was used for meta-analysis.RESULTS: Three RCTs involving 643 patients were included. Compared to conventional medicine treatment alone, ligustrazine plus conventional medicine treatment showed significant difference in reduction of stroke recurrence either at the end of 1-year follow-up [RR=0.42, 95% CI(0.18, 0.94), P< 0.05] or 3-years observation [RR=0.48, 95% CI(0.27, 0.83), P