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=.009), along with indications suggesting that these procedures required larger median volumes of contrast medium (225 versus 175 mL, OR=5.5, P=.008) as well as a longer median fluoroscopy duration (123.6 versus 99.3 minutes, OR=3.0, P=.06). Our data did not suggest that delayed leukoencephalopathy was associated with the number of coils (P=.57), microguidewires (P=.35), and guiding systems (P=.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.