ENDOVASCULAR STENT PLACEMENT IN A PATIENT WITH NICKEL ALLERGY

Abstract

<h3>Introduction</h3> Medical hardware presents unique challenges in patients with metal allergy. There is a paucity of large-scale studies involving endovascular stents and metal allergy, although numerous case reports describe endovascular stent failure due to such allergy. Here we present a case of successful peripheral artery stent placement in a patient with nickel allergy. <h3>Case Description</h3> A 72-year-old female with type II diabetes, hypertension, and peripheral vascular disease was hospitalized for a gangrenous toe complicated by osteomyelitis, and severe iliac stenosis requiring stenting versus bypass. The allergy service was consulted because she was scheduled for stent placement but reported history of nickel allergy. Time constraints precluded patch testing, but since having her ears pierced in college she had experienced multiple weeping rashes after exposure to nickel-containing jewelry, her most recent within two months prior to our consult. The intended stainless steel stent had 10-12% nickel content, but was coated with ePTFE, previously shown to ameliorate contact allergy to pacemakers. Due to lack of data, we were unable to predict potential reaction to the stent and discussed possible outcomes with the patient, including diffuse rash and potential stent restenosis. Ultimately, the patient opted for stent placement. Two days after stenting, she developed a pruritic morbilliform rash, which improved with antihistamines and topical steroids and resolved completely with change of antibiotics. The stent remains patent 18 months after placement, and the rash has not recurred. <h3>Discussion</h3> Although larger studies are needed, this case demonstrates that endovascular stenting may be tolerated in patients with nickel allergy.