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Baranoski JF, Catapano JS, Rutledge C, Cole TS, Majmundar N, Winkler EA, Srinivasan VM, Jadhav AP, Ducruet AF, Albuquerque FC. Endovascular Treatment of Cerebrovascular Lesions Using Nickel- or Nitinol-Containing Devices in Patients with Nickel Allergies. AJNR Am J Neuroradiol 2023; 44:939-942. [PMID: 37474263 PMCID: PMC10411833 DOI: 10.3174/ajnr.a7936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
Nickel is used in many cerebral endovascular treatment devices. However, nickel hypersensitivity is the most common metal allergy, and the relative risk of treatment in these patients is unknown. This retrospective analysis identified patients with nickel or metal allergies who underwent cerebral endovascular treatment with nickel-containing devices. Seven patients with nickel and/or other metal allergies underwent treatment with 9 nickel-containing devices. None experienced periprocedural complications. No patient received treatment with corticosteroids or antihistamines. At a mean clinical follow-up for all patients of 22.8 months (range, 10.5-38.0 months), no patients had symptoms attributable to nickel allergic reactions. The mean radiographic follow-up for all patients at 18.4 months (range, 2.5-37.5 months) showed successful treatment of the targeted vascular pathologies, with no evidence of in-stent stenosis or other allergic or hypersensitivity sequelae. The treatment of cerebrovascular lesions with a nickel-containing device resulted in no adverse outcomes among these patients and was safe and effective.
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Affiliation(s)
- J F Baranoski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - J S Catapano
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - C Rutledge
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - T S Cole
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - N Majmundar
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - E A Winkler
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - V M Srinivasan
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A P Jadhav
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A F Ducruet
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - F C Albuquerque
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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2
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Hu W, Jiang J. Hypersensitivity and in-stent restenosis in coronary stent materials. Front Bioeng Biotechnol 2022; 10:1003322. [PMID: 36185438 PMCID: PMC9521847 DOI: 10.3389/fbioe.2022.1003322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary heart disease (CHD) is a type of cardiovascular disease with the highest mortality rate worldwide. Percutaneous transluminal coronary intervention (PCI) is the most effective method for treating CHD. However, in-stent restenosis (ISR), a long-term complication after PCI, affects the prognosis of patients with CHD. Previous studies have suggested that hypersensitivity reactions induced by metallic components may be one of the reasons of this complication. With the emergence of first- and second-generation drug-eluting stents (DES), the efficacy and prognosis of patients with CHD have greatly improved, and the incidence of ISR has gradually decreased to less than 10%. Nevertheless, DES components have been reported to induce hypersensitivity reactions, either individually or synergistically, and cause local inflammation and neointima formation, leading to long-term adverse cardiovascular events. In this article, we described the relationship between ISR and hypersensitivity from different perspectives, including its possible pathogenesis, and discussed their potential influencing factors and clinical significance.
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Affiliation(s)
- Wansong Hu
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- *Correspondence: Jun Jiang,
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3
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Roach K, Roberts J. A comprehensive summary of disease variants implicated in metal allergy. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:279-341. [PMID: 35975293 PMCID: PMC9968405 DOI: 10.1080/10937404.2022.2104981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Allergic disease represents one of the most prominent global public health crises of the 21st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
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Affiliation(s)
- Ka Roach
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
| | - Jr Roberts
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
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Patel R, Moore W, Jimenez JC. Severe Symptomatic Nickel Allergy Following Stent-Graft Implantation Requiring Excision and External Iliac Artery Reconstruction. J Vasc Surg Cases Innov Tech 2022; 8:562-564. [PMID: 36248398 PMCID: PMC9556571 DOI: 10.1016/j.jvscit.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Although nickel allergy is a common cause of contact dermatitis, systemic reactions to nitinol stents are rare. A 61-year-old woman had presented with a nonhealing toe wound. Angiography revealed an external iliac artery stenosis, which was treated with a nitinol stent graft. However, she developed severe truncal pruritus, and within 3 months, her external iliac stent graft had thrombosed. Allergy testing revealed nickel sensitivity. After medical therapy had failed, stent graft removal was performed, resulting in complete resolution of her symptoms. The present case demonstrates a rare allergic reaction to the nitinol in commercially available stent grafts. Pruritus and rash are rare reactions to stenting; however, a nitinol allergy should be considered for patients with no other identifiable primary source.
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Affiliation(s)
- Rhusheet Patel
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wesley Moore
- Division of Vascular and Endovascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Juan Carlos Jimenez
- Division of Vascular and Endovascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Correspondence: Juan Carlos Jimenez, MD, MBA, Division of Vascular and Endovascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Ste 526, Los Angeles, CA 90095-6908
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5
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Wilson S, Mone P, Kansakar U, Jankauskas SS, Donkor K, Adebayo A, Varzideh F, Eacobacci M, Gambardella J, Lombardi A, Santulli G. Diabetes and restenosis. Cardiovasc Diabetol 2022; 21:23. [PMID: 35164744 PMCID: PMC8845371 DOI: 10.1186/s12933-022-01460-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 01/05/2023] Open
Abstract
Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.
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Affiliation(s)
- Scott Wilson
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Pasquale Mone
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Urna Kansakar
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Stanislovas S Jankauskas
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Kwame Donkor
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Ayobami Adebayo
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Fahimeh Varzideh
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael Eacobacci
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Jessica Gambardella
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA.
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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6
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Chioncel V, Andrei CL, Brezeanu R, Sinescu C, Avram A, Tatu AL. Some Perspectives on Hypersensitivity to Coronary Stents. Int J Gen Med 2021; 14:4327-4336. [PMID: 34408475 PMCID: PMC8364397 DOI: 10.2147/ijgm.s326679] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
The development of coronary stents has represented a revolution in the treatment of coronary heart disease. Beyond their many advantages, stents also have their limitations and complications. Allergic reactions to coronary stents are more common than acknowledged. These stented patients are exposed to foreign substances inserted in direct contact with the coronary intima. Hypersensitivity to stent components and drugs prescribed after stent insertion together with any environmental exposure seem to contribute to these adverse reactions. Patients can present to the hospital with a wide range of symptoms and multiple complications, the most important ones being instent restenosis and stent thrombosis. Although not very common (and not always easy to identify), allergic reactions after coronary or peripheral stents should be taken into account. Careful selection of patients (for elective stent implantation) depending on the propensity to allergies, although hard to achieve, represents a key factor in reducing the number of these complications.
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Affiliation(s)
- Valentin Chioncel
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Catalina Liliana Andrei
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Radu Brezeanu
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Crina Sinescu
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Anamaria Avram
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Alin Laurentiu Tatu
- Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform "Dunărea de Jos", ReForm-UDJG, Research Centre in the Field of Medical and Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Clinical Medical Department, "Dunărea de Jos" University of Galati, Galati, 800010, Romania
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7
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Coronary Stents and Metal Allergy. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Tanaka R. Recent Update on Peripheral Arterial Endovascular Therapy for Peripheral Arterial Occlusive Disease. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2020; 5:120-127. [PMID: 36284758 PMCID: PMC9550384 DOI: 10.22575/interventionalradiology.2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
Endovascular treatment is effective for symptomatic peripheral arterial disease (PAD). Following recent device improvements, favorable long-term outcomes have been achieved in iliac arteries as well as small arteries such as the femoral and popliteal arteries. This paper outlines the history and recent advances in endovascular treatment of peripheral vascular diseases as well as the characteristics and usage of devices. The history and the advances in endovascular treatment of peripheral vascular disease have been parallel, with the development of devices such as catheters and stents. Accordingly, endovascular treatment is now recommended in guidelines as the first-line for PAD.
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Affiliation(s)
- Ryoichi Tanaka
- Division of Dental Radiology, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University, Iwate, Japan
- Department of Radiology, Iwate Medical University, Iwate, Japan
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9
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Guntani A, Kawakubo E, Yoshiga R, Mii S. Metallic allergy requiring removal of iliac stent: report of a case. Surg Case Rep 2020; 6:82. [PMID: 32337621 PMCID: PMC7183569 DOI: 10.1186/s40792-020-00843-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of metallic stents, which are predominantly composed of nickel, in the treatment of patients with nickel allergy has not been well studied. CASE PRESENTATION A patient who suffered from contact dermatitis due to implantation of an iliac stent was successfully treated by removing the stent that caused nickel allergy. The patient has exhibited no symptoms of claudication or severe pruritic rash in the 2-year follow-up period after iliac stent removal. CONCLUSIONS We herein report a case of nickel allergy in which a metallic iliac stent that was predominantly composed of nickel was removed. The patient showed a marked recovery from her contact dermatitis. In cases of suspected metallic allergy, it is necessary to consider revascularization without using a metal device.
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Affiliation(s)
- Atsushi Guntani
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, 5-9-27 Haruno-machi, Yahatahigashi-ku, Kitakyushu, 805-8527, Japan.
| | - Eisuke Kawakubo
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, 5-9-27 Haruno-machi, Yahatahigashi-ku, Kitakyushu, 805-8527, Japan
| | - Ryosuke Yoshiga
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, 5-9-27 Haruno-machi, Yahatahigashi-ku, Kitakyushu, 805-8527, Japan
| | - Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, 5-9-27 Haruno-machi, Yahatahigashi-ku, Kitakyushu, 805-8527, Japan
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10
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Coronary Stents and Metal Allergy. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_81-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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12
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Kawatani Y, Kurobe H, Nakamura Y, Hori T. A case of nickel allergy after endovascular aortic repair. Asian Cardiovasc Thorac Ann 2018; 27:114-117. [DOI: 10.1177/0218492318784736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 78-year-old man with no history of allergy, underwent endovascular aortic repair for abdominal aortic aneurysm rupture. Postoperatively, he had low-grade fever and persistently raised white blood cell counts, but tests showed no infection. A skin rash appeared on the trunk and upper arms; we suspected a drug allergy. Despite withdrawal and/or change of medications, the symptoms remained. Finally, a patch test for nickel showed a strongly positive result. Oral prednisone 5 mg·day−1 was started, and the clinical findings resolved thereafter. No recurrence of allergy, infection, or exacerbation of the treated abdominal aortic aneurysm was noted at the 2-year follow-up.
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Affiliation(s)
- Yohei Kawatani
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Hirotsugu Kurobe
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Takaki Hori
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
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Slodownik D, Danenberg C, Merkin D, Swaid F, Moshe S, Ingber A, Lotan H, Durst R. Coronary stent restenosis and the association with allergy to metal content of 316L stainless steel. Cardiovasc J Afr 2018; 29:43-45. [PMID: 29443350 PMCID: PMC6002789 DOI: 10.5830/cvja-2017-036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/13/2017] [Indexed: 11/06/2022] Open
Abstract
Background Most intra-coronary stents in use are made of 316 L stainless steel, which contains nickel, chromate and molybdenum. Whether inflammatory and allergic reactions to metals contribute to in-stent restenosis is still a matter of debate. Aim The aim of this study was to ascertain the relationship between metal allergy and the occurrence of in-stent restenosis. Methods Ninety-nine adult patients who underwent two cardiac catheterisations, up to two years apart, were included in the study. Seventy patients had patent stents at the second angiogram (patent stent group) and 29 were found to have in-stent restenosis (restenosis group). All patients underwent patch testing with the relevant metals and the 316L stainless steel plate. Results Twenty-eight (28.3%) patients were found to have an allergy to at least one metal. There was no significant difference in the prevalence of metal allergy between the patent stent group and the restenosis group (28.6 and 27.6%, respectively; p = 0.921). Conclusion Our data do not support the theory that contact allergy plays a role in the pathogenesis of in-stent restenosis.
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Affiliation(s)
- D Slodownik
- Department of Dermatology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
| | - C Danenberg
- Cardiology Division, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - D Merkin
- Cardiology Division, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - F Swaid
- Department of Dermatology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - S Moshe
- Sackler Faculty of Medicine, School of Public Health, Department of Environmental and Occupational Health, Tel Aviv University, Tel Aviv, Israel
| | - A Ingber
- Department of Dermatology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - H Lotan
- Cardiology Division, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - R Durst
- Cardiology Division, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
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Univers J, Long C, Tonks SA, Freeman MB. Systemic hypersensitivity reaction to endovascular stainless steel stent. J Vasc Surg 2017; 67:615-617. [PMID: 29248243 DOI: 10.1016/j.jvs.2017.08.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
Endovascular intervention has become the mainstay for treatment of most patients suffering from peripheral vascular disease. We describe a patient with a known nickel allergy who underwent placement of a stainless steel stent for aortoiliac occlusive disease. Despite our attempt to avoid a nickel-containing stent, the patient developed a diffuse rash consistent with a nickel or metal allergy. A review of stainless steel metallurgy revealed that nickel, cobalt, and titanium are frequently used to provide anticorrosive properties to stainless steel. The clinical significance of the use of nickel-alloy stents in the setting of patients with a nickel allergy is discussed.
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Affiliation(s)
- Junior Univers
- Division of Vascular Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn.
| | - Chandler Long
- Division of Vascular Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Stephen A Tonks
- Division of Vascular Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Michael B Freeman
- Division of Vascular Surgery, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
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15
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Prosthetic and Device Surgery Considerations. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Konishi T, Yamamoto T, Funayama N, Yamaguchi B, Sakurai S, Nishihara H, Yamazaki K, Kashiwagi Y, Sasa Y, Gima M, Tanaka H, Hotta D, Kikuchi K. Stent thrombosis caused by metal allergy complicated by protein S deficiency and heparin-induced thrombocytopenia: a case report and review of the literature. Thromb J 2015; 13:25. [PMID: 26207097 PMCID: PMC4512022 DOI: 10.1186/s12959-015-0055-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/25/2015] [Indexed: 12/18/2022] Open
Abstract
A 43-year-old woman recipient of a bare metal coronary stent during an acute anterior myocardial infarction was repeatedly hospitalized with recurrent stent thrombosis (ST) over the following 3 years. Emergent coronary angiography showed a thrombus in the in-stent segment of the proximal left anterior descending artery. We repeatedly aspirated the thrombus, which immediately reformed multiple times. The discontinuation of heparin and administration of thrombolytics and argatroban, followed by repeated balloon dilatations, ended the formation of new thrombi. The patient was found to be allergic to nickel, protein S deficient and carrier of heparin-induced thrombocytopenia antibody. We discuss this case in the context of a) literature pertaining to acute coronary syndromes in the young, and b) the detailed investigations needed to identify thrombotic risk factors. Steroids may be effective to prevent recurrent ST caused by stent allergy.
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Affiliation(s)
- Takao Konishi
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
- />Department of Translational Pathology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Tadashi Yamamoto
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Naohiro Funayama
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Beni Yamaguchi
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Seiichiro Sakurai
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Hiroshi Nishihara
- />Department of Translational Pathology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Koko Yamazaki
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Yusuke Kashiwagi
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Yasuki Sasa
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Mitsuru Gima
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Hideichi Tanaka
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Daisuke Hotta
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
| | - Kenjiro Kikuchi
- />Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan
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Spanos K, Drakou A, Giannoukas AD. Should we consider nickel allergy a potential factor associated with peripheral stent patency? Vascular 2014; 23:220. [DOI: 10.1177/1708538114565207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Spanos
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Aikaterini Drakou
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Abstract
Allergic contact dermatitis to nickel is a continued health concern internationally. Nickel has been found to be the most prevalent and relevant allergen in tested populations for the last 3 decades. Furthermore, recent data from the North American Contact Dermatitis Group demonstrate positive patch-test reactions to nickel at approximately 19.5% of their tested population and a significant increase in the positivity rates for the last decade (Dermatitis. 2013;24:10-21. J Am Acad Dermatol. 1998;38:911-918). Because of the rise in allergic contact dermatitis rates to nickel, the American Contact Dermatitis Society recognized nickel to be the 2008 Allergen of the Year (J Am Acad Dermatol. 2009;60:1067-1069; Dermatitis. 2008;19:3-8). This article recognizes the importance of nickel avoidance and highlights potential alternatives.
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