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Clinical neurology
Case series
Safety of intracranial venous stenting in patients with nickel allergy
  1. Margaret McGrath1,
  2. Julian Clarke1,
  3. Jackson P Midtlien2,3,
  4. Kyle M Fargen2,3,
  5. Haider Ali4,5,
  6. Matthew R Amans4,5,
  7. Ferdinand Hui6,
  8. Waleed Brinjikji7,
  9. Michael R Levitt1,8
    1. 1Neurological Surgery, University of Washington, Seattle, Washington, USA
    2. 2Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
    3. 3Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
    4. 4Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, San Francisco, California, USA
    5. 5Neurological Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
    6. 6Neurointerventional Surgery, The Queen’s Medical Center, Honolulu, Hawaii, USA
    7. 7Radiology, Mayo Clinic, Rochester, Minnesota, USA
    8. 8Radiology, Neurology, Mechanical Engineering, Stroke & Applied Neuroscience Center, University of Washington School of Medicine, Seattle, Washington, USA
    1. Correspondence to Dr Michael R Levitt; mlevitt{at}uw.edu

    Abstract

    Background Nickel hypersensitivity is the most common metal related allergy. Nickel containing alloys are frequently used in endovascular devices. The use of intracranial stents in patients with nickel hypersensitivity appears to be safe, but these small series only evaluated arterial stent placement. This case series aimed to assess the safety of intracranial venous stent placement in patients with documented nickel allergy.

    Methods In this retrospective multicenter case series, patients with idiopathic intracranial hypertension and documented nickel allergy underwent treatment with a permanently implanted nickel containing stent in the dural venous sinuses.

    Results Nine patients with nickel allergy were included. All patients reported clinical improvement in their idiopathic intracranial hypertension symptoms. Of the five patients who had follow-up intracranial venous imaging, all stents remained patent. No patients experienced intraoperative, postoperative, or long term procedure related complications, with follow-up ranging from 1.8 weeks to 49.1 months.

    Conclusion In this limited case series, the use of nickel containing stents in intracranial venous sinuses in patients with nickel allergy did not result in any allergic reaction or adverse outcome.

    • Stent
    • Intracranial Pressure
    • Stenosis

    https://doi.org/10.1136/jnis-2024-022094

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      Footnotes

      • X @mattamansMD, @DrMichaelLevitt

      • Correction notice Since this paper first published, table 1 has been updated.

      • Contributors MM: substantial contribution to the conception of the work, analysis, interpretation of the data, original drafting of the manuscript and revising it critically for important intellectual content, and approval of final draft. JC: substantial contribution to the drafting of the work and revision for final production, and approval of final draft. JPM, KMF, HA, MRA, FH, and WB: substantial contribution to the conception of the work, provided cases from the collaborating institution, contributed with revising the draft critically for important intellectual content, and approval of final draft. MRL: initiation of the collaborative project, substantial contribution to the conception of the work and analysis and interpretation of the data, drafting of the manuscript, revising it critically for important intellectual content, and approval of final draft.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests KMF: ownership interests in NeuroVenous Technologies and editorial board of Journal of NeuroInterventional Surgery. MRA: consultant for Stryker; data safety monitoring board for Microvention; consultant, equity, and board of directors for VS3 Medical; equity VDF Industries; editorial board of Journal of NeuroInterventional Surgery; and board of directors of Society of NeuroInterventional Surgery. FH: unrestricted educational grants from Stryker and Microvention (grant No not available); equity interests in Bendit and NeuroVenous Technologies; and data safety monitoring board for Microvention. WB: editorial board of Interventional Neuroradiology. MRL: unrestricted educational grants from Medtronic and Stryker (grant numbers not available); equity interest in Proprio, Synchron, Hyperion Surgical, Stroke Diagnostics, Fluid Biomed, and Apertur; consulting for Aeaean Advisers, Metis Innovative, Genomadix, and Stereotaxis; data safety monitoring board of Arsenal Medical; and editorial board of Journal of NeuroInterventional Surgery.

      • Provenance and peer review Not commissioned; externally peer reviewed.