BACKGROUND: It remains unclear whether neuroimaging markers of cerebral small-vessel disease (CSVD) affect the outcomes of patients with acute ischemic stroke receiving endovascular treatment (EVT). The aim of this systematic review and meta-analysis was to evaluate the association between CSVD neuroimaging markers and outcomes in patients with acute ischemic stroke undergoing EVT. METHODS: We conducted a systematic search of PubMed and EMBASE databases up to July 2022 using keywords or Medical Subject Heading terms ("cerebral small-vessel diseases," "leukoaraiosis," "microbleed," "enlarged perivascular space," "recent small subcortical infarct," "atrophy," "lacune," and "thrombectomy"). The assessed clinical outcomes were a good functional outcome, 90-day mortality, symptomatic intracranial hemorrhage, and early neurologic improvement after EVT. RESULTS: Overall, 30 studies on patients with acute ischemic stroke undergoing EVT were included. Patients with absent or mild white matter hyperintensities had higher good functional outcomes (odds ratio [OR], 2.94 [95% CI, 2.44-3.53]; P<0.001) and lower mortality rate (OR, 0.42 [95% CI, 0.11-1.59]; P<0.001), whereas the presence of cerebral microbleeds increased only the risk of 90-day mortality (OR, 0.60 [95% CI, 0.44-0.83]; P=0.002). Moreover, patients with moderate/severe CSVD burden had worse functional outcomes than those with none/mild CSVD burden (OR, 2.94 [95% CI, 2.44-3.53]; P<0.001), but neither mortality nor symptomatic intracranial hemorrhage was significantly different between the 2 groups. CONCLUSIONS: The existence of CSVD affected the outcomes of patients with acute ischemic stroke receiving EVT. Future multicenter prospective cohort studies with little heterogeneity should be prioritized to confirm our results.