245 - Do Smaller Stents Prevent Hepatic Encephalopathy? A Comparative Study of Constrained and Conventional Transjugular Intrahepatic Portosystemic Shunt

Tuesday, April 14, 2026

4:21 PM - 4:30 PM ET

Presenting Author(s)

AS

Atsushi Saiga, MD, PhD

Assistant professor
Shizuoka cancer Center, Japan

Author/Co-author(s)

MH

Masahiro Horikawa, MD, MBA

Associate Professor
Dotter Department of Interventional Radiology, Oregon Health & Science University, United States
Kentaro Yamada, MD, PhD (he/him/his)

Research Assistant Professor
Oregon Health & Science University, United States
KM

Kenkichi Michimoto, MD, PhD (he/him/his)

Postdoctoral Scholar
Dotter Department of Interventional Radiology, Oregon Health & Science University, United States
TA

Takeshi Aramaki, M.D., Ph.D.

Director
Shizuoka cancer Center, Japan
John Kaufman, MD, FSIR, MS

Attending Physician
Dotter Interventional Institute, United States
RG

Ron C. Gaba, MD, MS

Professor
University of Illinois at Chicago, United States

Purpose: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for complications of portal hypertension but often leads to hepatic encephalopathy (HE). Primary constrained TIPS has been proposed to reduce HE incidence by limiting shunt flow. However, its effectiveness remains uncertain.

Materials and Methods: We retrospectively analyzed 99 patients who underwent intravascular ultrasound-guided TIPS placement between April 2013 and September 2017 at a single institution. Patients were divided into two groups: constrained TIPS (n = 45) and conventional TIPS (n = 54). Data collected included demographic characteristics, stent diameter, pre- and post-TIPS HE incidence, presence of concomitant antegrade embolization, collateral vessel visualization on final angiography, and post-TIPS portosystemic gradient.

Results: The incidence of post-TIPS HE was significantly higher in the constrained group than in the conventional group, despite achieving smaller stent diameters (median 7 mm vs. 10 mm, p = 0.0001). Multivariate analysis identified advanced age as a significant risk factor for HE, while concomitant antegrade embolization was associated with a trend toward reduced HE but did not reach statistical significance. No significant difference was observed in collateral vessel visualization between groups.

Conclusion: Primary constrained TIPS did not reduce the occurrence of HE compared to conventional TIPS. These findings suggest that while stent diameter is an important consideration, multiple patient- and procedure-related factors—particularly age and embolization—may have a greater influence on post-TIPS HE development. Further prospective studies are needed to clarify the role of constrained TIPS in HE prevention. The authors used ChatGPT (GPT-5 Mini) to assist with grammar and spelling during the preparation of this work.