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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(01): 25-31
DOI: 10.1055/s-0043-1770343
Original Article

Comparison of Balloon-Occluded Thrombolysis with Catheter-Directed Thrombolysis in Patients of Budd-Chiari Syndrome with Occluded Direct Intrahepatic Portosystemic Shunt

Amar Mukund 
1   Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Tanya Yadav
1   Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Satender Pal Singh 
2   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Saggere Muralikrishna Shasthry
2   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Rakhi Maiwall
2   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Yashwant Patidar 
1   Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Shiv Kumar Sarin
2   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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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

Author Contributions

A.M. was involved in conceptualization, methodology, reviewing, editing and finalizing the manuscript. T.Y. helped in data curation, data analysis, preparation of first draft of the manuscript. S.P.S. helped in data Curation and reviewing the manuscript. S.M.S. contributed to patient enrolling, clinical management, and methodology. R.M. helped in patient enrolling, clinical management, and data analysis. Y.P. helped in imaging evaluation of patients and reviewing the manuscript. S.K.S. was involved in supervising the research, reviewing, and editing to reach the final version of manuscript. Clinical trials.gov ID: NCT05117684.


Ethical Approval

Approval for the study was obtained from institutional review board (IEC/2021/86/MA15). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Informed Consent

This study has obtained IRB approval from (IEC/2021/86/MA15) and the need for informed consent was waived.


Consent for Publication

Consent for publication was obtained for every individual person's data included in the study.


Supplementary Material



Publication History

Article published online:
26 June 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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