BACKGROUND: Endovascular therapies (EVTs), including mechanical thrombectomy (MT) and intra-arterial thrombolysis (IAT) are becoming the standard of care for acute ischemic stroke management. However, little is known about the epidemiology of Post-stroke seizure (PSS) incidence in patients receiving EVT. AIM: The aim of this study was to evaluate the incidence of PSS, including early symptomatic seizure (ES) and late seizure or post-stroke epilepsy (PSE) in patients treated with EVT for acute ischemic stroke. Also, to identify the factors that may influence the incidence of PSS in these patients. METHOD: We conducted a systematic review and meta-analysis of published studies indexed in PubMed, Web of Science, and Google Scholar, from inception to September 2023. A Meta-analysis was conducted using IBM SPSS 29 RESULTS: 18 articles were finally included in our review, with a pooled total of 41,056 participants. The cumulative incidence of PSS was 9.0 % (CI: [8.2 %-9.9 %]). The incidence of ES was 3.8 % [3.4 %-4.2 %], and late seizures (PSE) was 6.8 % [6.0 %-7.6 %]. Hemorrhagic transformation (OR: 2.04 CI: [1.59-2.62]), cortical involvement (OR: 1.71 [1.21-2.41]), and infarct size>
1/3 of the affected territories (OR: 4.15 [3.02-5.73]) were associated with an increased risk of PSS. Female sex (OR: 0.89[0.81-0.98]) and a 3 months mRS 0-2 (OR: 0.36 [0.22-0.60]) were both associated with a reduced PSS incidence. CONCLUSION: This study suggests that PSS incidence is not higher in patients receiving EVT, and the associated risk factors are similar to those in patients treated by other therapeutic options.