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

作　　者：Martin Rossle Dominik Bettinger Robert Thimme Michael Schultheiss 

机构地区：[1]Department of Medicine II,Medical Center University of Freiburg,Faculty of Medicine,University of Freiburg,Freiburg,Germany [2]Berta-Ottenstein-Programme,Faculty of Medicine,University of Freiburg,German

出　　处：《iLIVER》2023年第2期89-96,共8页国际肝胆健康（英文）

摘　　要：Background and aims:The present treatment goal of the transjugular intrahepatic portosystemic shunt(TIPS)is a portosystemic pressure gradient of12 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 7.21.0 mm,but different post-TIPS gradients(9.71.9 mmHg,4.51.5 mmHg,and 14.21.4 mmHg,p<0.001),relative reduction of pre-TIPS gradients(51.711.4%,73.611.1%,and 34.09.1%,p<0.001),and specific reduction per mm of stent diameter(7.52.0%/mm,10.12.0%/mm,and 4.81.4%/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).

关 键 词：Portal hypertension Transjugular intrahepatic portosystemic stentshunt TIPS Portosystemic pressure gradient Stent diameter Hepatic encephalopathy Cardiac function 

分 类 号：R575[医药卫生—消化系统]