Bioresorbable vascular scaffold to treat malignant in-stent restenosis in a patient with nickel allergy

Jurado-Román, Alfonso; López-Lluva, María T.; Sanchez-Perez, Ignacio; Piqueras‐Flores, Jesús; Maseda, Ramón; Lozano-Ruíz-Poveda, Fernando

doi:10.1016/j.carrev.2016.12.020

Cited by 4 publications

(5 citation statements)

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“…Deficits had collectively presented alongside speech difficulties 19 or difficulties in undertaking movement. 42 Status epilepticus and migraines, implicated 2 patients 19 , 42 and 4 patients respectively of the sub-group of neurological adverse reactions. 21 , 33 , 35 , 38 In 2 patients, the migraine and headache collectively presented with aura.…”

Section: Resultsmentioning

confidence: 99%

“…This was undertaken by 33 patients, with 1 patient unable to undertake the test following the severity of her reactions 20 and 3 patients with unspecified methods of confirmation. 40 , 42 , 51 However, 5 patients also displayed allergies to other metals, including cobalt, mercury, and palladium. Two patients depicted positive cutaneous manifestations following patch testing of the soon-implanted metallic device.…”

Section: Resultsmentioning

confidence: 99%

“…Residual symptoms include intermittent recurrence of rash as described by Guerra et al . 18 , 22 , 39 , 42 , 43 , 46 2 Patients reported radiological cessation, but 1 patient had merely improvement of radiological symptoms. 39 There was no reported death secondary to nickel-hypersensitivity reaction in the identified literature.…”

Section: Resultsmentioning

confidence: 99%

“…Bioresorbable stents with steroid-incorporated vascular scaffolds have also been suggested as a novel alternative for symptomatic management, although information pertaining to its outcomes remains limited. 42 Novel embolic agents may be considered as alternatives to nickel-containing vascular occlusive devices in patients with nickel allergy. Gong et al 63 highlighted the use of Glubran-2 cyanoacrylate adhesive to achieve arterial embolisation in patients with acute renal haemorrhage.…”

Section: Discussionmentioning

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%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Previous case reports have demonstrated repeated incidence of ISR after receiving CoCr stents in patients with proven nickel allergy. After switching to bio-absorbable vascular stents ( Jurado-Roman et al, 2017 ) and prednisolone anti-allergic treatment ( Nakajima et al, 2016 ) after PCI, the patients’ prognosis significantly improved. In 2016, Nakajima also reported a case of recurrent ISR and overt metal allergy after implantation of CoCr everolimus-eluting stents (CoCr—EES), in which recurrent restenosis was terminated with prednisolone and tranilast treatment ( Nakajima et al, 2016 ).…”

Section: Hypersensitivity Of Coronary Stent Materialsmentioning

confidence: 99%

Hypersensitivity and in-stent restenosis in coronary stent materials

Jiang

2022

Front. Bioeng. Biotechnol.

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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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Nickel hypersensitivity and endovascular devices: a systematic review and meta-analysis

Guéroult

Al‐Balah

Davies

et al. 2021

Heart

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ObjectiveNickel allergy is common; endovascular specialists are often confronted with nickel allergic patients ahead of the implantation of endovascular devices, many of which are nickel-containing. Our aim was to elucidate whether nickel hypersensitivity is significantly associated with worse or adverse outcomes after placement of a nickel-containing endovascular device.MethodsInclusion criteria were: endovascular and transcatheter procedures for coronary, structural heart, neurovascular and peripheral vascular pathology involving nickel-allergic patients. All adverse outcomes were included as defined by included studies. A systematic review and meta-analysis were undertaken using a random-effects model. Searches of MEDLINE and EMBASE were conducted for articles published 1947–2019.Results190 records were identified, 78 articles were included for qualitative synthesis and 15 met criteria for meta-analysis. Patch-test confirmed nickel allergy was associated with an increased risk of adverse outcomes following implantation of a nickel-containing endovascular device (n=14 articles, 1740 patients; OR 2.61, 95% CI 1.41 to 4.85). This finding further was observed in coronary (n=12 articles, 1624 patients; OR 1.94, 95% CI 1.16 to 3.23) and structural heart subgroups (n=2 articles, 83 patients; OR 52.28, 95% CI 1.31 to 2079.14), but not in the neurovascular subgroup (n=1 article, 33 patients; OR 3.04, 95% CI 0.59 to 15.72) or with a patient-reported history of nickel allergy (n=2 articles, 207 patients; OR 2.14, 95% CI 0.23 to 19.70).ConclusionsPatch-tested nickel allergy is associated with an increased risk of adverse outcomes following endovascular device implantation and alternative treatment options should be considered. Specialists faced with patients’ self-reporting nickel allergy should consider proceeding to diagnostic patch-testing.

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Bioresorbable vascular scaffold to treat malignant in-stent restenosis in a patient with nickel allergy

Cited by 4 publications

References 4 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

Hypersensitivity and in-stent restenosis in coronary stent materials

Nickel hypersensitivity and endovascular devices: a systematic review and meta-analysis

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