Treatment of refractory post-transjugular portosystemic stent-shunt encephalopathy: a novel case of stent luminal reduction.

Encephalopathy is a significant complication of transjugular intrahepatic portosystemic stent-shunt (TIPSS). The majority respond to medical treatment but a proportion prove recalcitrant to conservative measures and eventually require some modulation of shunt blood flow in order to ameliorate their symptoms. This is particularly relevant in patients for whom TIPSS has been performed as a rescue procedure and are not suitable for liver transplantation (OLT). We describe a novel approach to the reduction of the diameter of the stent-shunt in TIPSS in an encephalopathic patient. This involved the creation of a waist around a standard covered stent and its subsequent introduction into a pre-existing TIPSS. This proved to be a successful procedure resulting in the alleviation of the patient's encephalopathy.