{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T02:51:16Z","timestamp":1770519076704,"version":"3.49.0"},"reference-count":7,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2021,8,15]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>In-stent stenosis (ISS) triggered by a metal-induced allergic reaction of Pipeline embolization device (PED) placement is extremely rare. The present report describes a patient who presented with delayed parent artery occlusion and refractory ISS after PED placement due to cobalt allergy. A patient in her 70s underwent PED placement for a right internal carotid artery (ICA) large aneurysm; 4 months later, the patient presented with left-sided hemiparesis, and MRI revealed right ICA occlusion even though antiplatelet therapy was optimal. She underwent mechanical thrombectomy, and successful recanalization was achieved. However, follow-up angiography 6 months after the thrombectomy revealed severe ISS, and the patch testing showed a positive reaction for cobalt. As a result of long-term administration of oral steroids and antihistamine, progression of ISS was suppressed. It was supposed that a delayed hypersensitivity reaction to cobalt might induce refractory ISS after PED placement.<\/jats:p>","DOI":"10.1136\/neurintsurg-2021-017948","type":"journal-article","created":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T17:40:17Z","timestamp":1629913217000},"page":"e4-e4","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Refractory in-stent stenosis after flow diverter stenting associated with delayed cobalt allergic reaction"],"prefix":"10.1136","volume":"14","author":[{"given":"Shoko","family":"Fujii","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5240-6884","authenticated-orcid":false,"given":"Kyohei","family":"Fujita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroto","family":"Yamaoka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Miki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakyo","family":"Hirai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Nemoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1348-1099","authenticated-orcid":false,"given":"Kazutaka","family":"Sumita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"2024052306531064000_14.4.e4.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03262-1"},{"key":"2024052306531064000_14.4.e4.2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2015-011981.rep"},{"key":"2024052306531064000_14.4.e4.3","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2017-013005.rep"},{"key":"2024052306531064000_14.4.e4.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-012-1048-2"},{"key":"2024052306531064000_14.4.e4.5","doi-asserted-by":"crossref","first-page":"376","DOI":"10.5797\/jnet.cr.2019-0008","article-title":"Parent artery stenosis and visual disturbance after balloon-assisted coil embolization of an unruptured cerebral aneurysm: a case report","volume":"13","author":"Goto","year":"2019","journal-title":"Noushinkei Kekkannai Tiryou"},{"key":"2024052306531064000_14.4.e4.6","first-page":"249","article-title":"Diagnosis and management of contact dermatitis","volume":"82","author":"Usatine","year":"2010","journal-title":"Am Fam Physician"},{"key":"2024052306531064000_14.4.e4.7","doi-asserted-by":"publisher","DOI":"10.1177\/0003319715604768"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/neurintsurg-2021-017948","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T13:53:21Z","timestamp":1716472401000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/neurintsurg-2021-017948"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,25]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,3,18]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/neurintsurg-2021-017948"],"URL":"https:\/\/doi.org\/10.1136\/neurintsurg-2021-017948","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,25]]}}}