Systemic hypersensitivity reaction to endovascular stainless steel stent

Univers, Junior; Long, Chandler A.; Tonks, Stephen A.; Freeman, Michael B.

doi:10.1016/j.jvs.2017.08.085

Cited by 19 publications

(16 citation statements)

References 6 publications

(5 reference statements)

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“…The safety profile was highly favorable in both groups, including no stent-related adverse events and no secondary glaucoma surgeries. The device is made of biocompatible material and notably does not contain nickel, which is widely known to be pro-inflammatory and has warranted restrictive regulations in the European Union [58][59][60][61][62][63][64][65][66]. Nickel allergy is present in an estimated 8-19% of the general population [59], most of whom are not aware of the allergy, which is a real concern for a permanent implanted device.…”

Section: Discussionmentioning

confidence: 99%

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

Manning

2019

Ophthalmol Ther

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Introduction: This real-world retrospective case series assessed 12-month effectiveness and safety following implantation of iStent Ò or iStent inject Ò trabecular micro-bypass with cataract surgery. Methods: Consecutive patients were implanted with either iStent (comprising 1 stent) or iStent inject (comprising 2 stents), together with cataract surgery. Most patients had primary openangle glaucoma. Effectiveness outcomes through 12 months included intraocular pressure (IOP) and glaucoma medications. Proportional analyses were completed for eyes achieving IOP B 18 mmHg, IOP B 15 mmHg, or IOP reduction C 20% from preoperative; and eyes on 0 medications or C 2 medications. Safety outcomes included adverse events, secondary surgeries, visual acuity, and visual fields. Results: This analysis included 137 eyes (67 iStent, 70 iStent inject) with cataract and mild to moderate glaucoma or ocular hypertension. Over 73% of eyes in both groups had early disease, and * 22% had prior glaucoma surgery. At 12 months postoperatively, mean IOP decreased from 18.4 ± 4.2 mmHg to 14.2 ± 2.5 mmHg in iStent eyes (p \ 0.0001), and from 20.4 ± 5.6 mmHg to 14.4 ± 2.1 mmHg in iStent inject eyes (p \ 0.0001). The IOP reduction was significantly greater for iStent inject eyes than iStent eyes (6.0 mmHg versus 4.2 mmHg reduction, p = 0.034). Both groups had high proportions of patients achieving the 12-month IOP endpoints, although consistently greater proportions reached these endpoints after iStent inject than iStent: 95.7% versus 92.5% had IOP B 18 mmHg, respectively; 74.3% versus 71.6% had IOP B 15 mmHg, respectively; and 68.6% versus 62.7% had IOP reduction C 20% from baseline, respectively. Mean medication burden at 12 months decreased from 1.8 ± 0.7 to 0.3 ± 0.5 medications in iStent eyes (84.0% reduction, p \ 0.0001), and from 1.3 ± 0.9 to 0.1 ± 0.3 medications in iStent inject eyes (94.7% reduction, p \ 0.0001). Significantly more iStent inject eyes were medication-free at 12 months than iStent eyes (92.9% versus 76.1% medication-free, respectively; p = 0.0068). Favorable safety included few adverse events, no secondary glaucoma surgeries, and stable visual acuity and visual fields in both groups. Conclusion: Significant and safe IOP and medication reductions were achieved through 12 months after iStent or iStent inject implantation with cataract surgery. iStent inject eyes Enhanced digital features To view enhanced digital features for this article go to

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Section: Discussionmentioning

confidence: 99%

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

Manning

2019

Ophthalmol Ther

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“…While rare, reactions to implanted devices in patients with metal allergies (including nickel) exist in the literature (Fahrni et al 2015;Stamm et al 2017;Clague et al 2012). Furthermore, the metallic content of endovascular devices is not always apparent (Univers et al 2018). Therefore, the use of a shape memory polymer vascular plug was considered a reasonable strategy to minimise the potential of an allergic reaction to implanted metallic embolic material in a patient with a known hypersensitivity, and especially in an ovarian vein case, where a large amount of embolic material is often implanted.…”

Section: Casementioning

confidence: 99%

Shape memory polymer ovarian vein embolisation in a patient with nickel allergy

et al. 2021

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Background Ovarian vein embolization in pelvic varicocele is usually obtained using nitinol coils. These devices can not be used in patients with proven nickel allergy. Case presentation Shape memory polymer is a new embolic material available to interventionalists. A patient presented with pelvic congestion syndrome requiring embolisation of the left ovarian vein. The target vessel consisted of two twisted branches, each 5–6 mm in diameter. The patient also had a known allergy to nickel. Considering the anatomy and allergy status, embolisation with polyurethane shape memory polymer vascular plugs was considered a good case strategy. The embolisation procedure was technically successful with the deployment of two shape memory polymer plugs into each of the two left ovarian vein branches. Follow-up magnetic resonance imaging at 4 months showed sustained occlusion of the treated vessels and the patient showed no signs of allergy to the implanted material. Conclusions In conclusion, our case presented an opportunity to utilise a new embolic material and achieve a good outcome in a patient with an allergy that may have resulted in complications when using metallic implants.

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“…While rare, reactions to implanted devices in patients with metal allergies (including nickel) exist in the literature [2][3][4]. Furthermore, the metallic content of endovascular devices is not always apparent [5]. Therefore, the use of a shape memory polymer vascular plug was considered a reasonable strategy to minimise the potential of an allergic reaction to implanted metallic embolic material in a patient with a known hypersensitivity, and especially in an ovarian vein case, where a large amount of embolic material is often implanted.…”

Section: Casementioning

confidence: 99%

Shape memory polymer ovarian vein embolisation in a patient with nickel allergy

Castellano

Boghi

Maggio³

et al. 2021

Preprint

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Background: ovarian vein embolization in pelvic varicocele is usually obtained using nitinol coils. These devices can not be used in patients with proven nickel allergy.Case presentation: shape memory polymer is a new embolic material available to interventionalists. A patient presented with pelvic congestion syndrome requiring embolisation of the left ovarian vein. The target vessel consisted of two twisted branches, each 5-6 mm in diameter. The patient also had a known allergy to nickel. Considering the anatomy and allergy status, embolisation with polyurethane shape memory polymer vascular plugs was considered a good case strategy. The embolisation procedure was technically successful with the deployment of two shape memory polymer plugs into each of the two left ovarian vein branches. Follow-up magnetic resonance imaging at 4 months showed sustained occlusion of the treated vessels and the patient showed no signs of allergy to the implanted material.Conclusions: in conclusion, our case presented an opportunity to utilise a new embolic material and achieve a good outcome in a patient with an allergy that may have resulted in complications when using metallic implants.

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Systemic hypersensitivity reaction to endovascular stainless steel stent

Cited by 19 publications

References 6 publications

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

Shape memory polymer ovarian vein embolisation in a patient with nickel allergy

Shape memory polymer ovarian vein embolisation in a patient with nickel allergy

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