Introduction Titanium allergies are rare. Most devices used for cerebral aneurysm treatment contain titanium, and titanium allergy can significantly limit treatment options. We discuss a case report of a patient with titanium allergy who underwent stent-assisted coil embolization of a basilar tip aneurysm with a titanium-free device and the pertinent literature review.
Case Report A 57-year-old female with medical history of hypertension, hyperlipidemia, and prior skin intolerance to metal jewelry had a CT angiogram of the head and neck for headaches and hypertension with incidentally found basilar tip aneurysm. Diagnostic cerebral angiogram confirmed the 4.3 mm x 5.3 mm x 5.6 mm wide necked basilar tip aneurysm. Given her prior skin metal intolerance, she underwent allergy patch testing with positive reaction to titanium oxide. Initially, given the wide-necked characteristic of her basilar tip aneurysm, embolization was planned utilizing WEB device, composed of Nitinol (combination of nickel and titanium). However, given her titanium allergy, an alternative strategy needed to be employed. After reviewing make up of several devices, she underwent a successful stent-assisted coil embolization of the basilar tip aneurysm with a cobalt platinum coronary bare metal stent. Though it did not conform well to the vessel wall due to its rigid characteristics, it provided good neck coverage and allowed successful coil embolization of the aneurysm. 10-month repeat cerebral angiogram showed no residual filling of the basilar aneurysm or in-stent stenosis.
Discussion Titanium allergy is an under recognized entity. Titanium allergies are documented in the literature, with proposed rates in the general population of 0.9-7.9%. Allergy to titanium oxides, as in our patient, is the rarest. Titanium is a component in nitinol-based devices in combination with nickel and surgical clips are also made of titanium. Thus, treatment options for wide necked aneurysms are limited. Allergic reactions to titanium are not well understood, but have been reported as type IV hypersensitivity reactions manifested as cutaneous rashes or delayed-onset in-stent stenosis in cardiac stenting. Neurological reactions to titanium allergies are less well documented. As many implantable medical devices contain various metal alloys including titanium, care should be taken before implanting such devices, including utilizing devices composed of alternative materials in those with known titanium allergies to prevent local or systemic allergic responses.
Disclosures J. Santucci: None. A. Mahapatra: None. M. Hussain: None.
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