Probable delayed-type hypersensitivity to nickel-containing cerebral aneurysm clip associated with neurologic deficits

Schmidlin, Kristin; Verzwyvelt, Joseph; Bernstein, David I.; Kim, Hae Jin

doi:10.1016/j.jaip.2015.02.004

Cited by 9 publications

(17 citation statements)

References 9 publications

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“…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. For example, joint replacements containing nickel have been associated with poor wound healing, recurrent joint effusion, pain, and implant loosening [63], while neurosurgical nickel-containing aneurysm clips have been implicated in life-threatening strokes and seizure [67,68]. Not surprisingly given the biocompatible, nickel-free makeup of the iStent and iStent inject devices, there were no cases of intraocular inflammation or PAS in either group throughout the course of follow-up; this is in contrast to the reported PAS rates of up to 30% observed in trials of other MIGS devices with similar mechanism of action [69][70][71][72].…”

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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“…Systemic scleroderma was excluded. 1 From these observations, we diagnosed her with anti-RuvBL1/2 antibody-positive morphea and polymyositis. The normalization of her muscular strength and the serum levels of CK and aldolase was achieved with oral prednisolone 50 mg/day and azathioprine 100 mg/day in…”

Section: Case Of Anti-ruvbl1/2 Antibody-positive Morphea and Polymyosmentioning

confidence: 94%

“…Dear Editor, Contact hypersensitivity to metals is frequent in the general population but allergic patients often tolerate medical implants containing those metals. 1 Here, we report the case of a patient with severe nickel hypersensitivity presenting with neurological symptoms and cerebral lesions, which developed after the implantation of a nickel-containing stent.…”

mentioning

confidence: 99%

Hypersensitivity to an intracerebral stent and symptomatic cerebral lesions: A possible link?

Marcos-Gonzalez

Spoerl

Darbellay

et al. 2016

The Journal of Dermatology

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Dear Editor, Contact hypersensitivity to metals is frequent in the general population but allergic patients often tolerate medical implants containing those metals. 1 Here, we report the case of a patient with severe nickel hypersensitivity presenting with neurological symptoms and cerebral lesions, which developed after the implantation of a nickel-containing stent.A 45-year-old woman presented with recurrent paresthesia on the left side of the body 3 weeks after stenting of a right internal carotidal aneurysm with a nickel-containing stent (Pipeline â flex embolization device [diverter flow]; ev3, Paris, France). Magnetic resonance imaging (MRI) showed gadolinium-enhancing lesions located downstream of the stent and surrounding edema. An infectious or ischemic cause was excluded. Steroid treatment was administrated for 8 months. Symptoms and lesions cleared progressively. Three weeks after the withdrawal of steroid treatment, the patient presented with a relapse. MRI showed a moderate worsening of the known cerebral lesions and steroid treatment was reintroduced and is currently ongoing. Based on previous reports of allergic reactions to cerebral aneurysm clips, 1,2 a delayed hypersensitivity to the stent was suspected in our patient.Epicutaneous patch tests were performed with the European baseline series (Hermal, Reinbek, Germany) and a personal series, which included the stent, with IQ Ultra â patch test chambers (Chemotechnique Diagnostics, Vellinge, Sweden). Readings were performed on the 4th day. Patch testing with the stent was positive (+) and the skin biopsy of the reaction showed epidermal intercellular edema (spongiosis) with a dermal lymphocytic infiltrate containing a few eosinophils (Fig. 1), consistent with a delayed hypersensitivity reaction. The stent was composed of 75% cobalt chromium, 25% platinum tungsten and less than 2% nickel. Patch testing of cobalt and chrome, the two other components of the stent according to manufacturer, were negative. Patch testing with nickel had to be removed after 24 h on patient request because of an extreme reaction (+++). Patch tests were Figure 1. Clinical picture (upper left). Picture of the stent used in patch testing (upper right). Histopathological image (bottom) (hematoxylin-eosin, original magnification 920).

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“…52 Schmidlin et al described removal of a nickel-containing aneurysm clip and replacement with a titanium clip for an intracranial aneurysm. 19 Patient outcomes following nickel-related adverse events Assessment of mortality and morbidity. Symptomatic cessation occurred in 27 patients, 6 patients reported symptomatic improvement with residual symptoms.…”

Section: Diagnosis Of Nickel-related Hypersensitivity Reactionmentioning

confidence: 99%

“…Cardiovascular manifestations ranged from mild heart palpitations to pericardial tamponade. 19,20,30,39,41,45 In extracted studies, cardiovascular manifestations were accompanied by ECG changes. Variability in ECG changes had accompanied spatial location of the implanted device.…”

Section: Adverse Events and Postoperative Complications Relating To N...mentioning

confidence: 99%

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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Probable delayed-type hypersensitivity to nickel-containing cerebral aneurysm clip associated with neurologic deficits

Cited by 9 publications

References 9 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

Hypersensitivity to an intracerebral stent and symptomatic cerebral lesions: A possible link?

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

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