Metal allergic reaction in chronic refractory in-stent restenosis

Saito, Taro; Hokimoto, Seiji; Oshima, Syuichi; Noda, Katsuo; Kojyo, Yasuko; Matsunaga, Kayoko

doi:10.1016/j.carrev.2008.01.004

« Previous Next »Cardiovascular Revascularization Medicine
Volume 10, Issue 1 , Pages 17-22, January 2009

Metal allergic reaction in chronic refractory in-stent restenosis

Taro Saito
- Department of Cardiology, Fukuoka Wajiro Hospital, Higashi-ku, Fukuoka City, Japan
- Corresponding author. Department of Cardiology, Fukuoka Wajiro Hospital, Wajirogaoka 2-2-75, Higashi-ku, Fukuoka City, 811-0213, Japan. Tel.: +81 92 608 0001; fax: +81 92 607 3051.
Seiji Hokimoto
- Department of Cardiology, Kumamoto Chuo Hospital, Tainoshima, Kumamoto City, Japan
Syuichi Oshima
- Department of Cardiology, Kumamoto Chuo Hospital, Tainoshima, Kumamoto City, Japan
Katsuo Noda
- Department of Cardiology, Kumamoto Chuo Hospital, Tainoshima, Kumamoto City, Japan
Yasuko Kojyo
- Department of Dermatology, Kumamoto Chuo Hospital, Tainoshima, Kumamoto City, Japan
Kayoko Matsunaga
- Department of Dermatology, Fujita Health University Hospital, Kutsukake-cyo, Toyoake City, Japan (Dermatological core lab)

Received 26 November 2007; received in revised form 6 January 2008; accepted 18 January 2008.

Abstract

Objectives

This study examined the relationship between chronic refractory (CR) in-stent restenosis (ISR) and metal allergic reaction.

Background

Although drug-eluting stent reduced the restenotic event compared with bare-metal stent, the mechanism of neointimal proliferation is not clear yet; however, bare-metal stent still remains as one of the choices.

Methods

Of 128 bare-metal stent implanted patients who experienced target lesion revascularization at least once, 60 patients with the second ISR (study group) and 68 patients without the second ISR (control group) were compared in terms of result from the skin patch test for metal allergic reaction.

Results

Nickel was dominant among components of 316L stainless steel. The nickel-positive was observed in 19% (24/128) of all patients. Of 24 nickel-positive, 18 (30%) was in the study group, whereas 6 (9%) was in the control group (P=.02). According to multivariate analysis, the most significant predictor for CR-ISR was reference vessel diameter (P=.0010) followed by nickel-positive (P=.0033) and hyperlipidemia (P=.0305). The nickel-positive showed the highest odds ratio of 5.41 adjusted with confounder variables.

Conclusion

This study with the second ISR showed that nickel was a major factor for CR-ISR. Further improvement of biocompatible material is required for coronary stents and strut-coating materials even in the drug-eluting stent era.

Keywords: Long term, Neointimal proliferation, Stents, Metal allergy