经颈静脉肝内门体分流术(TIPS)通过降低门腔压力梯度(PCG)缓解肝硬化并发症,但它缺乏精确的实现一个目标后TIPSPCG通过直径调整等直径支架。这项研究旨在提出一种可控的扩张,流线型,覆盖锥形支架,与等直径支架相比,研究了其对减压的影响。2017年12月至2021年2月在华西医院接受标准化8毫米支架TIPS植入的24例患者纳入本研究。在基于计算机断层扫描血管造影数据重建的TIPS后3维模型中创建了具有不同直径和流线型锥形支架的虚拟等直径支架移植物。数值模拟显示,只有两名患者获得了与临床有创测量一致的TIPS后目标PCG。当使用6毫米和10毫米等直径支架时,大多数患者的模拟TIPS后PCGs仍在安全范围之外,在支架-门静脉吻合处观察到再循环流。相比之下,新的流线型锥形支架的使用导致24名患者中有17名患者的TIPS后PCGs在10-12mmHg范围内,在吻合部位没有观察到再循环流。总之,流线型锥形支架可以有效解决两个不同等直径支架之间的大跳跃降压问题,并且可以改善PV支架锚固附近区域的血液动力学。因此,流线型锥形支架可能是TIPS手术的一种较好的替代方案.
Transjugular intrahepatic portosystemic shunt (TIPS) relieves cirrhotic complications by reducing portacaval pressure gradient (PCG), but it lacks precision in achieving a targeted post-TIPS PCG simply through diameter adjustment of equal diameter stents. This study aimed to present a controlled-expansion, streamlined, and covered tapered stent, and examined its effects on pressure reduction compared with equal- diameter stents. Twenty-four patients who underwent standardized 8-mm stent TIPS implantation at West China Hospital from December 2017 to February 2021 were included in the current study. Virtual equal-diameter stent graft with different diameter and streamlined tapered stents were created in the post-TIPS 3-dimentional models reconstructed based on computed tomography angiography data. The numerical simulation showed that only two patients achieved targeted post-TIPS PCG consistent with the clinical invasive measurement. When 6-mm and 10-mm equal-diameter stents were employed, simulated post-TIPS PCGs for most patients remained outside the safe range, and recirculating flow was observed at the stent-portal vein anastomosis. In contrast, the use of the new streamlined taper stent resulted in post-TIPS PCGs within the 10-12 mmHg range for 17 out of 24 patients, with no recirculating flow observed at the anastomotic sites. In conclusion, the streamlined tapered stent could pose an effective solution to the problem that the big jump depressurization between two different equal-diameter stents and it would improve the hemodynamics in the region near the PV-stent anchorage. Therefore, the streamlined tapered stent may present a superior alternative for TIPS procedure.