Endovascular device implants detrimental to patients with confirmed nickel allergy

Patch-test confirmed nickel hypersensitivity appears to heighten the risk of adverse outcomes following implantation of a nickel-containing endovascular device, a study has found.

Nickel allergy is common, with endovascular specialists frequently encountering patients with the said hypersensitivity ahead of the implantation of endovascular devices, many of which contain nickel. So, the researchers conducted a systematic review and meta-analysis of trials evaluating endovascular and transcatheter procedures for coronary, structural heart, neurovascular and peripheral vascular pathology in nickel-allergic patients.

The initial search yielded 190 records, of which 78 articles were included for qualitative synthesis and 15 met criteria for meta-analysis. All the included studies reported adverse outcomes after placement of a nickel-containing endovascular device.

Pooled data, obtained using a random-effects model, showed that patch-test confirmed nickel allergy contributed to an increased risk of adverse outcomes following implantation of a nickel-containing endovascular device (14 articles, 1,740 patients; odds ratio [OR], 2.61, 95 percent confidence interval [CI], 1.41–4.85).

The same association was seen among patients in the coronary (12 articles, 1,624 patients; OR, 1.94, 95 percent CI, 1.16–3.23) and structural heart subgroups (two articles, 83 patients; OR, 52.28, 95 percent CI, 1.31–2,079.14). There was no risk increase observed in the neurovascular subgroup (one article, 33 patients; OR, 3.04, 95 percent CI, 0.59–15.72) or with a patient-reported history of nickel allergy (two articles, 207 patients; OR, 2.14, 95 percent CI, 0.23–19.70).

The findings suggest that alternative treatment options should be considered for patients with confirmed nickel hypersensitivity. Specialists who manage patient with self-reported nickel allergy should proceed to diagnostic patch-testing.