Incidence and influencing factors of post-stroke seizure after endovascular treatment of ischemic stroke – A systematic review and meta-analysis

Abstract

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.