Stent implantation in patients with metal allergy

Gong, Zimu; Li, Min; Guo, Xiang; Zhi, Ma; Shi, Jingpu

doi:10.1097/mca.0b013e3283647ad1

Cited by 25 publications

(11 citation statements)

References 19 publications

(31 reference statements)

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“…Nitinol is a nickel‐titanium alloy and nickel is a potential sensitizer which can give rise to hypersensitivity‐associated events. However, with conflicting reports in the setting of percutaneous coronary intervention , there is currently little evidence that nickel allergy has a cause‐effect relationship with adverse cardiovascular clinical events. There are indeed reported cases of symptoms of allergic reaction to metal in case of PFO or ASD closure, mainly related to the occurrence of postimplantation chest discomfort or palpitations but without any evidence of an associated increase in the occurrence of device‐associated thrombosis (DAT) .…”

mentioning

confidence: 99%

Rebuttal with regards to “Device‐associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet”

Lempereur

Aminian

Saw

2017

Cathet Cardio Intervent

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mentioning

confidence: 99%

Rebuttal with regards to “Device‐associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet”

Lempereur

Aminian

Saw

2017

Cathet Cardio Intervent

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“…Another interesting finding is that the Carotid Wallstent is the only one made of unique cobalt-chromium-iron-nickel-molybdenum alloy containing an enhanced radiopaque tantalum core, whereas all other stents from our group are made of Nitinol (nickel-titanium alloy). There are data suggesting that in some cases in-stent restenosis may be influenced by metal allergy [19], including hypersensitivity to molybdenum [20]. The Carotid Wallstent also has the smallest free cell area in the CC group, 1.1 mm 2 ; while for Xact it is 2.7 mm 2 and ≥ 4 mm 2 for other stents.…”

Section: Discussionmentioning

confidence: 99%

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Tekieli¹,

Musiałek²,

Kabłak‐Ziembicka³

et al. 2019

pwki

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Introduction: Optimal management of severe carotid in-stent restenosis remains unknown. Prevalence and risk factors of first and recurrent carotid in-stent restenosis in the multi-stent approach have not been established yet. Aim: To evaluate the safety of different methods of endovascular treatment of carotid in-stent restenosis/recurrent restenosis and to establish its rate and risk factors. Material and methods: Between January 2001 and June 2016, 2637 neuroprotected carotid artery stenting (CAS) procedures were performed in 2443 patients (men: 67.0%; mean age: 67.9 ±8.8 years, symptomatic: 45.5%). Doppler ultrasound (DUS) evaluation was performed at discharge, after 3-6 months, 12 months, and then annually. Peak systolic velocity of 2-3 and > 3.0 m/s as well as end diastolic velocity of 0.5-0.9 and > 0.9 m/s were DUS criteria for 50-69% and ≥ 70% carotid in-stent restenosis (ISR) respectively. For angiographically confirmed ≥ 70% stenosis balloon re-angioplasty was first line treatment. Results: Out of 95 DUS detected > 50% ISR (95/2637; 3.6%), 53 were confirmed in angiography as ≥ 70% (53/2637; 2.0%, one total occlusion). All patients were treated with bare balloon (n = 19), drug-eluting balloon (n = 27) or stent-supported (n = 6) angioplasty. One procedure was complicated with stroke (1.9%). Angiographic diameter stenosis (DS) was reduced from 83 ±8.3% to 13 ±7.6% (p < 0.001). There were 13 cases of ≥ 70% recurrent ISR. Bilateral and high-grade stenosis were independent risk factors of restenosis. Initial Carotid Wallstent implantation was a risk factor of first and recurrent in-stent restenosis. Conclusions: Endovascular treatment of carotid in-stent restenosis is safe. Bilateral and high-grade carotid artery stenosis may increase the risk of restenosis. Initial Carotid Wallstent implantation may increase the risk of first and recurrent restenosis.

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“…Honari et al [105] reached the same conclusion after an extensive review of the literature in 2008, namely, that studies performed until then often involve a limited number of patients and known risk factors (eg, stent length, reference diameter, patient characteristics including diabetes, and smoking) may confound the results. However, a recent meta-analysis of 9 studies by Gong et al [110] in 2013 (total of 1223 patients) arrived at the opposite conclusion, namely, having a pre-existing metal allergy increases the risk of ISR, with an odds ratio of 2.65. The study also found that the odds ratio for Asian patients was higher than for European patients (3.71 vs 2.25), suggesting that the former group may be more susceptible to ISR.…”

Section: Intravascular Devicesmentioning

confidence: 97%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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Stent implantation in patients with metal allergy

Abstract: Allergy to stent material worsens the prognosis of patients with coronary stent implantation. New well-designed prospective clinical trials are required to confirm this relationship and to establish the indispensability of a skin patch test before coronary stent implantation.

Cited by 25 publications

References 19 publications

Rebuttal with regards to “Device‐associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet”

Rebuttal with regards to “Device‐associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet”

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

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