Transjugular intrahepatic portosystemic shunt does not alter cerebral blood flow.

BACKGROUND & AIMS: Cirrhosis patients with symptomatic portal hypertension might be effectively treated with a transjugular intrahepatic portosystemic shunt stent (TIPS). The intervention, however, carries a risk of debilitating portosystemic hepatic encephalopathy (HE). HE in cirrhosis might be associated with decreased cerebral blood flow (CBF), and CBF might decrease after TIPS.
METHODS: We measured CBF by [(15)O]-water positron emission tomography (PET) in 9 nonencephalopathic cirrhosis patients before and median 11 days after the insertion of TIPS. The PET images were co-registered to magnetic resonance images for region-based analysis.
RESULTS: Pre-TIPS whole-brain CBF varied markedly from very low to high-normal values of 0.28-0.58 mL blood/mL of brain tissue/min. There were no systematic changes in whole-brain or regional CBF after the TIPS treatment (P > .1). No patient had HE after TIPS.
CONCLUSIONS: Treating portal hypertension by TIPS in patients with advanced cirrhosis and without HE had no effect on their CBF and seemed not to entail a risk of cerebral hypoperfusion.