Key result
Nickel allergy linked to refractory recurrent ISR despite multiple stents and drug-coated balloons.
Case Report (n=1)
No
Metal allergy, specifically to nickel, can be a cause of refractory recurrent in-stent restenosis despite multiple interventional and pharmacological strategies.
Nickel allergy may explain refractory restenosis; this case leaves open whether pre-procedural screening improves outcomes.
This article describes the case of a middle-aged woman who developed recurrent in-stent restenosis (ISR) due to metal allergy. The first ISR occurred after implantation of a nickel-rich Medtronic Endeavor Resolute stent (35% nickel, 35% cobalt, and 20% chromium). A skin patch test revealed a strong nickel allergy (++), with no allergic reaction to cobalt. Nickel allergy was considered to be the cause of the first ISR. Then, a drug-coated balloon platinum-chromium alloy stent was implanted, and ISR occurred again during follow-up. The article discusses this special case and clinically relevant management options. This case highlights a scenario with refractory in-stent restenosis persisting despite various treatment strategies, including stents with different metal components, drug-coated balloons, and intensive drug therapy.
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Li et al. (2026) conducted a case report in Recurrent coronary artery in-stent restenosis (n=1). Different metal stents, drug-coated balloons, and Shexiang Baoxin Pills was evaluated on Recurrent in-stent restenosis. A 48-year-old woman with a nickel allergy experienced refractory recurrent in-stent restenosis despite treatment with different metal stents, drug-coated balloons, and intensive drug therapy.
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