A novel approach to nickel allergy in neurointerventional surgery: Peripheral arterial stent testing protocol to guide the choice of cerebral aneurysm treatment

Objective

This study aims to determine the outcomes of nickel allergic patients who underwent a trial of forearm arterial stenting with a nickel-based stent, with follow-up to assess for an allergic reaction. In the absence of adverse effects, patients had their intracranial aneurysm treatment with a nickel-based cerebrovascular device.

Methods

A retrospective analysis was performed on patients who had an allergy to nickel, with an intracranial aneurysm who underwent treatment with a permanently implanted nickel-containing device. Nickel allergy was established by clinical history and dedicated patch testing. Outcomes such as in-stent thrombosis or any intracranial complications were recorded.

Results

Over a 10-year period, there were 18 patients who had a peripheral stent without development of in-stent stenosis, thrombosis or occlusion. One patient developed a cutaneous allergic reaction to the peripheral stent and their intracranial procedure was with a nitinol-free device.

Of 17 patients who underwent intracranial treatment with a nitinol device, there was one patient who developed a postoperative complication of fish-mouthing of the device which has been reported in patients with a nickel contact allergy, but further studies are warranted to establish a causative relationship. Another patient omitted prescribed antiplatelet medication and occluded their stent. The remaining fifteen patients developed no complications with aneurysm occlusion on imaging.

Conclusion

Patients with a nickel allergy who would be eligible for endovascular treatment could benefit from trial peripheral arterial stenting. This provides an alternative approach to avoid unnecessarily eliminating endovascular treatment options with nickel-containing devices from which these patients may potentially still benefit.