- Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms
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.
- Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results of Embolization of Intracranial Aneurysms at 1 Year: A Randomized Trial
Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, parallel, randomized, controlled clinical trial. Patients had 4- to 12-mm unruptured aneurysms. Treatment allocation to either 15- (experimental group) or 10-caliber coils (control group) was randomized 1:1 using a Web-based platform. The primary efficacy outcome was a major recurrence or a residual aneurysm at follow-up angiography at 12 ± 2 months adjudicated by an independent core lab blinded to the treatment allocation. The trial was stopped after 210 patients were recruited between November 2013 and June 2017 when funding was interrupted. On an intent-to-treat analysis, the primary outcome was reached in 37 patients allocated to 15-caliber coils and 36 patients allocated to 10-caliber coils. Safety and other clinical outcomes were similar. Coiling of aneurysms randomized to 15-caliber coils achieved higher packing densities compared with 10-caliber coils, but this had no impact on the angiographic outcomes at 1 year, which were primarily driven by aneurysm size and initial angiographic results.
Welcome to the new AJNR, Updated Hall of Fame, and more. Read the full announcements.
AJNR is seeking candidates for the position of Associate Section Editor, AJNR Case Collection. Read the full announcement.