Anderson Chun On Tsang1, Patrick Nicholson2, Vitor Mendes Pereira2. 1. Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong. Electronic address: acotsang@hku.hk. 2. Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Nickel is the most common metal allergen and predominantly affects women. It is also the ubiquitous component in the alloys used to manufacture intracranial devices for aneurysm treatments, including aneurysm clips, self-expanding stents, flow-diverting stents, and endosaccular occlusion devices. Adverse events related to nickel allergy after deployment of such devices are uncommon but can be severe, resulting in dilemmas in the choice of treatment strategies and devices in managing nickel-sensitive patients with intracranial aneurysms. METHODS: A literature search was performed in accordance with the PRISMA guidelines to identify studies reporting on nickel-related adverse events in patients being treated for cerebral aneurysm. The materials of the culprit devices, clinical presentation, histological features, and treatments were reviewed. Clinical considerations and management options for nickel allergy patients were evaluated. RESULTS: Nickel is a major component of the cobalt alloy used in aneurysm clips and also of nitinol, which is commonly used in flow diverters and intracranial stents. Our literature review identified 9 articles reporting 10 unique cases of nickel-related adverse events after aneurysm treatment. Five of the cases occurred after aneurysm clipping, and the other 5 were attributed to endovascular devices. Two patients presented with dermatologic manifestations and 8 with neurologic manifestations, including cerebral edema and cerebritis. CONCLUSIONS: Neurologic complications related to nickel in cerebral aneurysm treatments are rare but remain concern owing to the high prevalence of nickel allergy in the population. Surgeons and interventionists should consider the metal allergy history and its potential clinical significance in managing nickel-allergic patients with aneurysms.
BACKGROUND:Nickel is the most common metal allergen and predominantly affects women. It is also the ubiquitous component in the alloys used to manufacture intracranial devices for aneurysm treatments, including aneurysm clips, self-expanding stents, flow-diverting stents, and endosaccular occlusion devices. Adverse events related to nickelallergy after deployment of such devices are uncommon but can be severe, resulting in dilemmas in the choice of treatment strategies and devices in managing nickel-sensitive patients with intracranial aneurysms. METHODS: A literature search was performed in accordance with the PRISMA guidelines to identify studies reporting on nickel-related adverse events in patients being treated for cerebral aneurysm. The materials of the culprit devices, clinical presentation, histological features, and treatments were reviewed. Clinical considerations and management options for nickelallergypatients were evaluated. RESULTS:Nickel is a major component of the cobalt alloy used in aneurysm clips and also of nitinol, which is commonly used in flow diverters and intracranial stents. Our literature review identified 9 articles reporting 10 unique cases of nickel-related adverse events after aneurysm treatment. Five of the cases occurred after aneurysm clipping, and the other 5 were attributed to endovascular devices. Two patients presented with dermatologic manifestations and 8 with neurologic manifestations, including cerebral edema and cerebritis. CONCLUSIONS: Neurologic complications related to nickel in cerebral aneurysm treatments are rare but remain concern owing to the high prevalence of nickelallergy in the population. Surgeons and interventionists should consider the metalallergy history and its potential clinical significance in managing nickel-allergicpatients with aneurysms.
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