RO recommends a reboot if it detects that a system process was injected. The only way to fully clear the infection is to kill the system process (which can be bad itself) or to reboot. It would not have fixed that issue at the end. That piece of ransomware screws with some registry settings to change default file actions for a variety of file types (shortcuts being one of them which is why they all turned blank). The latest RO update adds protection against that kind of damage and will restore some of the modified values.
For executables that are loaded in memory, you can't modify the file on disk. You can rename the file and recreate a new one named the exact same thing but it won't have any impact on the processes that are currently using that file. And for system files especially, due to caching probably won't have any impact to new processes that also use that file (it will just use the cached copy). Now, when the system reboots and the original file was renamed and there is a new file in its place or none at all then that will cause all sort of problems. So still plenty of ways to cause havoc without actually having to encrypt.