Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms

Abstract

BACKGROUND AND PURPOSE: Delayed leukoencephalopathy is a rare complication that occurs after endovascular coiling of cerebral aneurysms. We aimed to describe a clinical picture of delayed leukoencephalopathy and explore potential associations with procedural characteristics. MATERIALS AND METHODS: We considered endovascular coiling procedures for cerebral aneurysms performed between January 2006 and December 2017 in our institution with follow-up MRIs. We used logistic regression models to estimate the ORs of delayed leukoencephalopathy for each procedural characteristic. RESULTS: We reviewed 1754 endovascular coiling procedures of 1594 aneurysms. Sixteen of 1722 (0.9%) procedures demonstrated delayed leukoencephalopathy on follow-up FLAIR MR imaging examinations after a median period of 71.5 days (interquartile range, 30-101 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. We found indications suggesting an association between delayed leukoencephalopathy and the number of microcatheters used per procedure (P 4 .009), along with indications suggesting that these procedures required larger median volumes of contrast medium (225 versus 175 mL, OR 4 5.5, P 4 .008) as well as a longer median fluoroscopy duration (123.6 versus 99.3 minutes, OR 4 3.0, P 4 .06). Our data did not suggest that delayed leukoencephalopathy was associated with the number of coils (P 4 .57), microguidewires (P 4 .35), and guiding systems (P 4 .57). CONCLUSIONS: Delayed leukoencephalopathy after coiling of cerebral aneurysms may have multiple etiologies such as foreign body emboli, contrast-induced encephalopathy, or hypersensitivity reaction to foreign bodies. ABBREVIATION: DL 4 delayed leukoencephalopathy E ndovascular coiling is an effective procedure for preventing rupture of cerebral aneurysms or treating ruptured aneurysms. 1,2 However, a small percentage of patients experience complications, 3 which include thromboembolic events (incidence rate of 4.7%-12.5%) and aneurysm rupture (incidence rate of 2.0%-8.8%), 3 along with posterior reversible encephalopathy

Delayed recurrent enhancing white matter lesions complicating coiling of intracranial aneurysm

“…The incidence of immune-mediated leukoencephalopathy in patients treated with EVT for intracranial aneurysms was estimated to be between 0.5% and 2.3% in various cohort studies [3][4][5]. Interestingly, the vast majority of the cases were women, aged 41-65 years.…”

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

“…Endovascular coiling is an effective technique for treating unruptured, ruptured aneurysms as well as preventing the rupture of cerebral aneurysms. 1 Studies have shown that, after endovascular interventions, a few patients experience complications such as thromboembolic events, aneurysm rupture, and perianeurysmal edema, which may be suggestive of symptomatic inflammatory responses. 1,19,20 Also, reversible encephalopathy syndrome has been observed in patients after endovascular interventions.…”

“…1 Studies have shown that, after endovascular interventions, a few patients experience complications such as thromboembolic events, aneurysm rupture, and perianeurysmal edema, which may be suggestive of symptomatic inflammatory responses. 1,19,20 Also, reversible encephalopathy syndrome has been observed in patients after endovascular interventions. 1,21,22 The possible mechanism of CIEP is as a result of disruption of the BBB leading to leakage of contrast agent into the cortex as well as subarachnoid space.…”

“…1,19,20 Also, reversible encephalopathy syndrome has been observed in patients after endovascular interventions. 1,21,22 The possible mechanism of CIEP is as a result of disruption of the BBB leading to leakage of contrast agent into the cortex as well as subarachnoid space. This event causes neurotoxicity as well as cortical edema.…”

“…Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. [1][2][3][4][5] The precise etiological mechanisms via which this occur is still a matter of debate. 2,4 Nevertheless, osmotic disruption of the blood-brain barrier (BBB) arising from repeated contrast injections into a single vessel has been speculated as a cause of this complication.…”