Cardiac stents may cause tingling in some patients

Coronary stents are commonly used to open blocked arteries of patients with coronary artery disease.

Increasingly, stents that release a drug that prevents recurrent narrowing of the coronary stents are used, and may cause numbness and tingling in some patients.

Paclitaxel-eluting stents (PESs) are commonly used to delivery the drug directly to the wall of the coronary artery and limit the growth of scar within the stents. Paclitaxel is a microtubule-stabilizing agent also used in the treatment of ovarian and breast cancer and its principal adverse effect is a sensory neuropathy.

A 65-year old man presented with symmetric numbness in all his extremities. In 2003 he had angioplasty and two PESs were deployed for angina. Three days later he noticed paresthesiae in his hands and feet. He had further angina and had four more PESs inserted in 2005 and 2006. His tingling worsened a few days subsequent to each stent placement. Neurological examination demonstrated normal muscle strength, mild vibration loss distally in his feet, and moderate, symmetric temperature and pinprick loss in his legs below his groin and in his hands below the elbows. Muscle stretch reflexes were symmetric and his gait was normal. Nerve conduction studies revealed findings suggestive of a generalized sensory ganglionopathy.

Neuropathy is seen in about 10% of patients receiving paclitaxel for cancer. It is postulated that in this patient, who had multiple PES over a 3-year period there may have been sufficient systemic release of paclitaxel resulting in sensory neuropathy. “Patients and physicians should be aware of this rare complication of a paclitaxel-eluting stent,” said lead author, Dr. Jayashri Srinivasan of Lahey Clinic in Burlington, Massachusetts.

The complete findings and results of this study are being presented at the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) 54th Annual Meeting in Phoenix, AZ, at the JW Marriott Desert Ridge, October 14-17, 2007. The AANEM is the largest organization worldwide, with over 5000 members dedicated to advancing neuromuscular, musculoskeletal, and electrodiagnostic medicine.