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Original Article | Open Access

The transjugular intrahepatic portosystemic shunt: Smaller stent diameters are required to optimize pressure response

Martin Rösslea( ), Dominik Bettingera, Robert Thimmea, Michael Schultheissb
Department of Medicine Ⅱ, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany
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Abstract

Background and aims

The present treatment goal of the transjugular intrahepatic portosystemic shunt (TIPS) is a portosystemic pressure gradient of ≤12 mmHg or its reduction by >50%. This study relates the stent diameter to the reduction of the pressure gradient and attempts to predict the appropriate stent diameter necessary to reach the treatment goal.

Methods

Pressure response, super response, and poor response were investigated in 208 de-novo TIPS patients and defined as post-TIPS gradients between >6 and 12 mmHg, ≤6 mmHg, or not reaching the goal (>12 mmHg, reduction <50%), respectively. Pressures were related to the smallest stent diameters measured by planimetry of the radiographic image.

Results

Responders (65%), super responders (26%), or poor responders (9%) had comparable stent diameters of 7.2 ± 1.0 mm, but different post-TIPS gradients (9.7 ± 1.9 mmHg, 4.5 ± 1.5 mmHg, and 14.2 ± 1.4 mmHg, p < 0.001), relative reduction of pre-TIPS gradients (51.7 ± 11.4%, 73.6 ± 11.1%, and 34.0 ± 9.1%, p < 0.001), and specific reduction per mm of stent diameter (7.5 ± 2.0%/mm, 10.1 ± 2.0%/mm, and 4.8 ± 1.4%/mm, p < 0.001). Prediction of the stent diameter required to reach response was not possible. Only two super responders had a stent diameter of <6 mm. Super and poor responders differed by the increase in the right atrial pressure (+5.0 mmHg vs. +3.1 mmHg, p = 0.026) and reduction in the portal vein pressure (−8.6 mmHg vs. −4.6 mmHg, p < 0.001).

Conclusion

Most patients reached the treatment goal with stent diameters of <8 mm. Overtreatment (super response, gradient ≤6 mmHg) can be prevented by stent diameters as small as 6 mm. The individual response was not related to the stent diameter and not predictable. Cardiac dysfunction may play an important role by its effect on the right atrial (preload) and portal pressure (afterload).

Keywords

Cardiac functionPortal hypertensionTransjugular intrahepatic portosystemic stent-shuntTIPSPortosystemic pressure gradientStent diameterHepatic encephalopathy

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iLIVER
Volume 2 Issue 2,
June 2023
Pages 89-96
DOI: 10.1016/j.iliver.2023.05.004
Cite this article:
Rössle M, Bettinger D, Thimme R, et al. The transjugular intrahepatic portosystemic shunt: Smaller stent diameters are required to optimize pressure response. iLIVER, 2023, 2(2): 89-96. https://doi.org/10.1016/j.iliver.2023.05.004

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Received: 21 February 2023
Revised: 07 May 2023
Accepted: 23 May 2023
Published: 27 May 2023
© 2023 Tsinghua University Press.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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