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Introduction Clinical outcome of endovascular treated stroke is dependent on multiple variables, resulting in a large inter-individual variability. In this context, secondary stroke injury such as post-ischemic leucoencephalopathy might be of relevance but has not been systematically investigated yet.Aim of Study Aim of the study was to uncover secondary phenomenon in follow-up-imaging, identify possible underlying reasons and examine for clinical impact.Method In a prospective, longitudinal single-center study endovascular treated patients were included and followed-up after 3–12 months by clinical and imaging investigations. Stroke lesions were segmented, microstructural alterations were assessed by analyzing DTImetrics and associations to clinical parameters were investigated.Abstract A209 Figure 1Results Within the cohort (n=81), 25 patients (31%) were identified with a lesion growth(LG) in the follow-up-imaging, either adjacent to primary stroke lesion or distant ( figure 1 and 2). DTI-metrics show a partially reversible loss of microstructural integrity (figure 2). 72% of the patients within the LGgroup can be identified with an underlying vascular pathology (vs. 39%, p<0.01), either with an acute carotid pathology and/or persisting stenosis in the follow-up. None of the LGpatients present with new clinical symptoms, but the LG-group shows a lower rate of neurological improvement (p<0.01) and higher follow-up-NIHSS-values (p=0.03), possibly mediated by greater infarct volume in the LGgroup.Abstract A209 Figure 2Conclusion The phenomenon of lesion growth in the follow-up with microstructural changes was seen for a high proportion and may be subsumed under the diagnosis post-ischemic leucencephalopathy. Underlying reasons for the secondary injury may be multifactorial, but the association to underlying vascular pathologies directs to a possible connection to disturbed vascular auto-regulation functions.Conflict of Interest No