TY - JOUR T1 - Response to: Correspondence on “Nickels and tines: the myth of nickel allergy in intracranial stents” by Apostolos <em>et al</em> JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 1287 LP - 1288 DO - 10.1136/neurintsurg-2022-018859 VL - 14 IS - 12 AU - Michael R Levitt AU - Kevin N Vanent AU - Emma M Federico AU - David I Bass AU - Guilherme Barros AU - Jade Keen Y1 - 2022/12/01 UR - http://jnis.bmj.com/content/14/12/1287.abstract N2 - We thank the authors for their interest1 in our benchtop study of nickel content and release in commonly used intracranial stents.2 We agree that an in vitro study such as ours is no substitute for the complex physiological environment of a living patient and that such results must be confirmed with careful clinical trials.The first nickel-containing intracranial aneurysm stent was approved for use 20 years ago,3 and since that time thousands of patients have been successfully treated with this groundbreaking technology. Nickel allergy is estimated to affect 10–20% of the world population,4 but the incidence of in-stent stenosis or thrombosis after intracranial stenting does not approach this number in the many real-world post-market studies of nickel-containing devices.5–7 Thus, while the possibility of nickel hypersensitivity to intracranial stents exists, the real-world experience of the past two decades suggests that such events are rare even among patients with documented nickel allergy, and much less than … ER -