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Delayed leukoencephalopathy is a rare complication that occurs after endovascular coiling of cerebral aneurysms and is found in the literature with several different names, such as delayed leukoencephalopathy, delayed enhancing lesions, and delayed multiple white matter lesions. Its various suggested etiologies include granulation reaction caused by foreign body emboli from the hydrophilic coating of procedural devices, contrast-induced encephalopathy, and nickel or bioactive polyglycolic/polylactic acid coil sensitivity. The authors analyzed 1754 endovascular coiling procedures of 1594 aneurysms. Sixteen procedures demonstrated delayed leukoencephalopathy on follow-up FLAIR MR imaging examinations after a median period of 71.5 days in the form of high-signal changes in the white matter at locations remote from the coil mass. Seven patients had headaches or hemiparesis, and 9 patients were asymptomatic. All imaging-associated changes improved subsequently. They found evidence of an association between delayed leukoencephalopathy and the number of microcatheters used per procedure, along with evidence suggesting that these procedures required larger median volumes of contrast medium and weak evidence regarding the need for a longer median fluoroscopy duration.

Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions. Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively. Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.