Abstract
Objectives Direct intrahepatic portosystemic shunt (DIPS) stent placement is an effective treatment
for patients with Budd-Chiari syndrome (BCS); however, thrombotic occlusion of DIPS
stent remains a cause of concern. The purpose of this study is to describe a novel
technique of balloon-occluded-thrombolysis (BOT) for occluded DIPS stent, and compare
it with the conventional catheter-directed-thrombolysis (CDT).
Methods In this retrospective study, the hospital database was searched for BCS patients
who underwent DIPS revision for thrombotic stent occlusion between January 2015 and
February 2021. Patients were divided into CDT group and BOT group. The groups were
compared for technical success, total dose of thrombolytic agent administered, duration
of hospital stay, and primary assisted stent patency rates at 1- and 6-month follow-up.
Results CDT was performed in 12 patients, whereas 21 patients underwent BOT. Complete recanalization
was achieved in 66.7% (8 of 12) patients of CDT group as compared to 81% (17 of 21)
patients of BOT group (nonsignificant difference, p = 0.420). BOT group had a short hospital stay (1.8 ± 0.7 vs. 3.5 ± 1.0 days) and
required less dose of thrombolytic agent ([2.2 ± 0.4]x105 IU versus [8.3 ± 2.9]x105 IU of urokinase) as compared to the CDT group and both differences were statistically
significant (p < 0.001). Further, 6-month patency rate was higher in BOT group as compared to CDT
group (p = 0.024).
Conclusion The novel BOT technique of DIPS revision allows longer contact time of thrombolytic
agent with the thrombi within the occluded stent. This helps in achieving fast recanalization
of thrombosed DIPS stent with a significantly less dose of thrombolytic agent required,
thus reducing the risk of systemic complications associated with thrombolytic administration.
Keywords direct intrahepatic portosystemic shunt - Budd-Chiari syndrome - thrombolysis - catheter-directed
thrombolysis
