Stent thrombosis caused by metal allergy complicated by protein S deficiency and heparin-induced thrombocytopenia: a case report and review of the literature

Konishi, Takao; Yamamoto, Tadashi; Funayama, Naohiro; Yamaguchi, Beni; Sakurai, Seiichiro; Nishihara, Hiroshi; Yamazaki, Kohko; Kashiwagi, Yusuke; Sasa, Yasuki; Gima, Mitsuru; Tanaka, Hideichi; Hotta, Daisuke; Kikuchi, Kenjiro

doi:10.1186/s12959-015-0055-z

Cited by 9 publications

(4 citation statements)

References 81 publications

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“…Total occlusion was mentioned by D’Arrigo et al in femoral artery stenting. 49 Konishi et al 50 reported thrombus formation and concurrent in-stent stenosis of Driver TM nickel- stent which led to ST-elevation myocardial infarction. Eosinophilic infiltra extracted from a thrombus was also demonstrated in post-mortem individuals who exhibited ST changes following endograft hypersensitivity.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, oral antihistamines were used in 5 patients in conjunction with steroid therapy. 17 , 18 , 23 , 45 , 50 In 3 patients, anti-platelet medications were administered, with 2 patients administered clopidogrel following an adverse reaction for the treatment of congenital heart diseases. 34 , 35 Following the severity of the hypersensitivity reaction, Guerra et al described one patient who was administered immunosuppressive therapy in the form of mycophenolic acid.…”

Section: Resultsmentioning

confidence: 99%

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Nickel-related hypersensitivity reactions following endovascular interventions: A review of current evidence

Tjen,

Yang

2023

Science Progress

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Introduction: Nickel is a principal alloying agent in the production of vascular endoprostheses, despite persisting as the most habitually identified allergen. Variable nickel-related hypersensitivity manifestations following endovascular intervention were reported, challenging established paradigms in treatment and accuracy of prognostic assessments. The objective of this review is to critically evaluate current metrics to maximise patient-related outcomes. Methods: A literature review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement. Patients indicative of nickel hypersensitivity reaction following endovascular intervention were discerned. A positive reaction was defined by patch testing, histological analysis, or anamnesis indicative of nickel hypersensitivity. Morphology of implicating prostheses, adverse events and postoperative complications, clinical course, diagnostic and therapeutic strategies alongside patient prognosis were recorded. Results: Nickel-related hypersensitivity reactions following endovascular repair were identified in 36 patients with a median age of 44.5 years. 20 patients received nitinol-containing intervention. 28 (77.8%) patients are female. Multi-organ adverse reactions occurred in 21 (58.3%) patients with variable latency. 14 (38.9%) patients were presented with neurological adverse reactions manifesting mainly as unilateral hemiparesis. Dermatological reactions implicated 16 (44.4%) patients. Miscellaneous manifestations include suicidal ideation. 13 (36.1%) patients displayed previous metal intolerance and 32 (88.9%) patients had positive patch testing for nickel. Histological analysis of lesions and prostheses indicated lymphocytic infiltration. 5 (13.9%) patients experienced device-specific reactions as in-stent restenosis or auxiliary distal vessel stenosis. 11 (30.1%) patients received solely medical therapy and 5 (13.9%) patients received solely surgical therapy. 19 (52.7%) patients underwent both medical (oral corticosteroid) and surgical therapy (device retrieval). 26 (77.1%) patients achieved symptomatic cessation, 6 (16.7%) patients exhibited symptomatic persistence and 0 patients died. Conclusion: Prophylactic pre-assessment for a history of metal allergy and consideration of prostheses alternatives is recommended to minimise reaction risk and severity. Despite nickel's predominant usage, information paucity urges additional studies to emphasise its implications and maximise patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Nickel-related hypersensitivity reactions following endovascular interventions: A review of current evidence

Tjen,

Yang

2023

Science Progress

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“…[68][69][70] Konishi et al reported a case with recurrent stent thrombosis in a patient with proved stent allergy who can benefit of systemic corticotherapy. 71 Besides antiplatelet therapy, low doses of steroids might confer clinical benefits and lower the incidence of stent thrombosis due to their anti-inflammatory properties.…”

Section: Stent Thrombosis/kounis Syndromementioning

confidence: 99%

Some Perspectives on Hypersensitivity to Coronary Stents

Chioncel¹,

Andrei²,

Brezeanu³

et al. 2021

IJGM

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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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“…The first generation of cardiovascular materials primarily consisted of stainless steel, titanium alloys, and cobalt chromium alloys . Although these metal alloys contain desirable properties, such as stiffness, strength, corrosive resistance, and haemocompatibility, direct contact with blood for a prolonged time interval can cause thrombosis . Therefore, over time metal alloys have been slowly replaced by synthetic polymers, including polyesters, polyurethanes, polyamides, and polytetrafluoroethylenes.…”

Section: Biomaterials Strategiesmentioning

confidence: 99%

Development of next generation cardiovascular therapeutics through bio‐assisted nanotechnology

Lakshmanan

Maulik

2017

J Biomed Mater Res

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Cardiovascular diseases (CVDs) rank, next to cancer and stroke, among the deadliest diseases in the world. Among the major CVDs, acute myocardial infarction is a lifethreatening disorder resulting from permanent damage to the left ventricular cardiac tissue. The major coronary arteries that supply blood to the functional left ventricle become blocked due to thrombotic plaque occlusion. During myocardial ischemia, oxidative stress and free radicals destroy healthy cardiomyocytes, smooth muscle cells, and endothelial cells, followed by degradation of the extracellular matrix, which results in ventricular wall-thinning and dilation. To protect the left ventricle from further damage and to rescue ischemic cardiac tissue, specially designed scaffolds consisting of biological material and nanomaterials have been developed. At the preclinical level, scaffolds loaded with growth factors and cells have been shown to regenerate ischemic tissue into healthy, functional myocardium. In this review, different therapeutic strategies currently available to treat the disease conditions at various stages are discussed, with special emphasis on biomaterials. Recent advancements in cardiovascular therapeutics using graphene and exosomal nanovesicles are discussed in detail. In addition, future directions for the development of next-generation cardiovascular therapeutics with biological and non-biological materials through nano-assisted technology are explored.

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Stent thrombosis caused by metal allergy complicated by protein S deficiency and heparin-induced thrombocytopenia: a case report and review of the literature

Cited by 9 publications

References 81 publications

Nickel-related hypersensitivity reactions following endovascular interventions: A review of current evidence

Nickel-related hypersensitivity reactions following endovascular interventions: A review of current evidence

Some Perspectives on Hypersensitivity to Coronary Stents

Development of next generation cardiovascular therapeutics through bio‐assisted nanotechnology

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