Fundamental principle of human biological system is to live in harmony with nature and environment.Each cell has a unique reaction when it comes into contact with external material. This reaction can be acute or chronic , local or systemic. The most severe form of allergy is called anaphylaxis that can result in instantaneous loss of life. There is a whole gamut of disorders that resulted in a separate speciality called allergic medicine .
Further ,the transplantation science have taught us an organ or cell can be rejected at any point of time after implantation (Hyperacute -chronic) .With advancement of science we have started implanting a variety of devices with complex metallurgy ,inside human body, metal clips, prosthesis, valves, wires, etc .How the body handles them .The consequences can be a mild reaction to major ones occasionally.
Consider ,a local allergy due to a orthopedic prosthesis in one of the leg bones is far less serious than a metal within a coronary artery irritating the intima .
Remember hypersensitivity reactions can be severe . This lady reacted like this to a sandal slipper -A fiery red infiltration
Imagine if a stented coronary artery react like this what would be the possible consequence ?
In susceptible individuals , can a metal cause
- Intimal hyperemia
- Intimal induration
- Intimo-medial edema following stent deployment
Why drug eluting stents are more prone for hypersensitivity ?
The answer is simple , while metal allergy is a comparatively rare phenomenon, the drugs we coat and the polymers used are many fold likely to result in hypersensitivity reaction.
While the world is worried more about penicillin , sulpha allergy which occurs in 1 in 100000 , we tend to ignore the metal and drug reactions within the tender coronary arteries.
What is the clinical expression of stent hypersensitivity ?
It is often a coronary event in the acute phase and restenosis in chronic phase.
How much of acute stent thrombosis is related to stent allergy mediated reaction ?
The exact incidence will never be known. It could be high. Whenever a sudden unexpected early stent occlusion can be a suspect .
Is stent allergy a local reaction or systemic reaction ?
It is most often local .The drugs the stent elute can elicit a systemic reaction occasionally.
So what can be done to prevent this complication ?
Drug companies in it’s package regularly include the warning message ! What does it imply to have a caution on the covers ? .This warning simply represent about our ignorance in this issue. We presume it is a minor problem.
Questions unanswered
- How does a cardiac patient knows whether he is hypersensitive to stainless steel or nickel ?
- Is it practical to have a stent allergic test in every patient before PCI ?
- Is routine administration of corticosteroids for few days after PCI an answer ?
Reference
Dr.S.Venkatesan MD 
My husband had a bare metal stent implanted 3 weeks ago. He has felt great until today. Low grade fever, body aches, weakness. flu or rejection? How concerned should we be? What are the odds? He is allergic to sulfur.
Do not be unduly worried about the Issue.
The stent allergy is a very rare event .
Follow the advices of your physician.
Dr venkatesan
“Do not be unduly worried about the Issue.
The stent allergy is a very rare event .
Follow the advices of your physician.
Dr venkatesan”
Actually stent rejection happens very frequently. Do your homework..
HAD STENT IN lad 1 in a half years ago. Its no longer.there. Not sure whay happen to it. Could of got infection per my doctor. had another one 2 weeks ago in the Ra have had a lot of pain in chest (heart area ) doctor said no problems should be there.. Had the same problem after I had the first one could my body be rejecting this one as well
My body has rejected 6 Stents and on bypass, what are my options? I have passed every stress test and after my open heart surgery played two games of rugby. My last stent lasted 36 days and the bypass lasted under two years.Dazed and confused in Ohio.
I had a titanium stent placed 725/2016.
I have had symptoms present themselves which were not present prior to coronary stent placement.
Elevated blood pressure.
Chronic moderate to severe pain in heart & extending to neck, throat & arms at times.
Chronic headache with pressure band around head above ears.
Extreme fatigue.
Exacerbated irritability.
The symptoms are increasing in intensity. I have a history of sensitivity to metals and of rejecting a synthetic prothesis in palate.
I am on aspirin & lowest dose of effient.
I am feeling a bit of urgency as I seek answers.
Thanks for any help & knowledge offered
Hi
Its true some develop reactions to metal.Fortunately its temporary.The body learns to adopt.Thats the greatness of biology.The drugs you take will make sure the stent doesnt get occluded.Steroids are anti Inflammatory agents that could help.
Keep in touch with your doc.
Be relaxed.Have a peaceful life.
Dr Venkatesan
Chennai.
India
Had a stent placed for blockage 7 days ago. Have been experiencing heart pain since and its getting worse. Dr. wanting to do perform another angioplasty to see what is going on. I am not thriled about that idea, but need this addressed. Never been told of possible rejection and wondering if this may be a issue of rejection. What are the symptoms of rejection? If this is rejection, should I wait and see if the pain settles down or proceed with angio? If it is rejection how is that diagnosed? What are the options? Not sure why no one explained about the possibility of rejection.
Hi,
Stent rejection is a rare event.
Need not result in any major adverse event.
It may just delay the process of healing.
Follow your cardiologist advice.
Dr.Venkatesan