Aortogenic emboli might play an important role in the development of delayed leukoencephalopathy after mechanical thrombectomy

A 76‐year‐old man developed delayed leukoencephalopathy 3 weeks after successful mechanical thrombectomy for middle cerebral artery occlusion. Pathological evaluation of the removed thrombus showed cholesterol clefts and fibrin with inflammatory cell infiltration, which were compatible with aortogenic embolism. Delayed leukoencephalopathy following recanalization in ischemic stroke has only been rarely reported, and the etiology in all the previously reported cases was cardioembolism, which is distinct from our case. Through this case, we considered that disruption of the blood–brain barrier caused by thrombus composed of cholesterol crystals and fibrin could be a trigger for delayed leukoencephalopathy. This case should provide better understanding of delayed leukoencephalopathy after acute ischemic stroke.