350 The Vasculitis Induced by the Cerebrovascular Coil

BACKGROUND: The treatment of a cerebrovascular coil is the popular treatment for the cerebral aneurysm. It is treatment to insert a metal coil in aneurysm. It is not reported the allergy of cerebrovascular coil. In Dec, 2019, a 57-year-old Japanese woman came to the neurosurgery hospital. The cerebral aneurysm was treated by coil embolization. Two days later, she was returned to hospital by left facial paralysis. Vasculitis was detected on the peripheral artery of the coil by MRI (magnetic resonance imaging). It was treated by prednisolone 60 mg/d, and paralysis was improved, although slightly remained sequelae. OBJECT: To understand of necessity of long term steroid therapy, we investigated metal allergy for coil. METHODS: The steroid was tapered and discontinued. The MRI was checked every 3 months. When vasculitis recurs, tapering is canceled. Three kinds of coils were used by embolization. Their coil consists of platinum and tungsten mainly, but it is unknown about the other component metal. After the steroid was discontinued, a patch test for 3 coil and LTT (lymphocyte transformation test) for the contrast medium was indicated. It was interpreted using ICDRG (INTERNATIONAL CONTACT DERMATITIS RESEARCH GROUP) criteria. It was given her informed consent to this study. RESULTS: After treatment of steroid, only Potassium bichromate was positive and other 17 metals, including the platinum was negative by the patch test. Two coils of the same type, was positive. The contrast medium was negative by LTT. One month later, new lesion of vasculitis was detected on the peripheral artery of the coil by MRI. CONCLUSIONS: It is a metal coil at risk of causing vasculitis. When it was treated by coil embolization, the check of the allergy to metal is recommended, because it was possible to experience permanent sequelae.