Ashkan Mollaiyan1, Dominik Bettinger2, Martin Rössle3. 1. University Hospital, Department of Radiology, Hugstetterstrasse 55, 79106 Freiburg, Germany. 2. University Hospital, Department of Gastroenterology, Hugstetterstrasse 55, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany. 3. University Hospital, Department of Gastroenterology, Hugstetterstrasse 55, 79106 Freiburg, Germany; Praxiszentrum für Gastroenterologie, Bertoldstrasse 48, 79098 Freiburg, Germany. Electronic address: Martin-Roessle@t-online.de.
Abstract
PURPOSE: This study investigates the behaviour of self-expanding nitinol stents at the time of TIPS-implantation and thereafter. METHODS: Hundred consecutive patients with cirrhosis receiving a TIPS revision were included. The smallest stent diameter was measured radiologically immediately after implantation and before shunt revision. Accuracy of the measurement was assessed by comparing the nominal stent diameter with the largest stent diameter measured at the time of revision. RESULTS: Pearson correlation between largest measured and nominal diameters was excellent (r=0.952, p<0.001) showing that measurements are accurate. At TIPS implantation all stents were markedly underdilated reaching only 76-92% of their nominal diameter. Smallest measured diameters were similar (8mm) irrespective of the nominal diameter (8, 9, 10mm) of the stent. In addition, smallest diameters of 10mm stents were similar irrespective whether 8, 9 or 10mm balloons were used. During a mean follow-up of 12.7±17.8months (median 3 months, range 1-81) stents expanded by 0.5-1.6mm dependent on the nominal stent size (8, 9, 10mm) and the grade of primary underdilation. No significant difference was found between Viatorr and bare stents. CONCLUSIONS: At TIPS-implantation, the compliance of the surrounding tissue predominantly determines the stent diameter. The nominal size of the stent or the dilatation balloon has little influence. Accurate adjustment of a desired pressure gradient is, therefore, not possible. During follow-up, stents expand towards their nominal diameter questioning the usefulness of underdilation.
PURPOSE: This study investigates the behaviour of self-expanding nitinol stents at the time of TIPS-implantation and thereafter. METHODS: Hundred consecutive patients with cirrhosis receiving a TIPS revision were included. The smallest stent diameter was measured radiologically immediately after implantation and before shunt revision. Accuracy of the measurement was assessed by comparing the nominal stent diameter with the largest stent diameter measured at the time of revision. RESULTS: Pearson correlation between largest measured and nominal diameters was excellent (r=0.952, p<0.001) showing that measurements are accurate. At TIPS implantation all stents were markedly underdilated reaching only 76-92% of their nominal diameter. Smallest measured diameters were similar (8mm) irrespective of the nominal diameter (8, 9, 10mm) of the stent. In addition, smallest diameters of 10mm stents were similar irrespective whether 8, 9 or 10mm balloons were used. During a mean follow-up of 12.7±17.8months (median 3 months, range 1-81) stents expanded by 0.5-1.6mm dependent on the nominal stent size (8, 9, 10mm) and the grade of primary underdilation. No significant difference was found between Viatorr and bare stents. CONCLUSIONS: At TIPS-implantation, the compliance of the surrounding tissue predominantly determines the stent diameter. The nominal size of the stent or the dilatation balloon has little influence. Accurate adjustment of a desired pressure gradient is, therefore, not possible. During follow-up, stents expand towards their nominal diameter questioning the usefulness of underdilation.
Authors: Guruprasad P Aithal; Naaventhan Palaniyappan; Louise China; Suvi Härmälä; Lucia Macken; Jennifer M Ryan; Emilie A Wilkes; Kevin Moore; Joanna A Leithead; Peter C Hayes; Alastair J O'Brien; Sumita Verma Journal: Gut Date: 2020-10-16 Impact factor: 23.059
Authors: Michael Praktiknjo; Jasmin Abu-Omar; Johannes Chang; Daniel Thomas; Christian Jansen; Patrick Kupczyk; Filippo Schepis; Juan Carlos Garcia-Pagan; Manuela Merli; Carsten Meyer; Christian P Strassburg; Claus C Pieper; Jonel Trebicka Journal: JHEP Rep Date: 2021-03-03