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Semin intervent Radiol 2024; 41(02): 220-225
DOI: 10.1055/s-0044-1786539
Morbidity & Mortality

Paradoxical Cerebral Embolization during Transjugular Intrahepatic Portosystemic Shunt Creation and Variceal Sclerotherapy

Richard Wu
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Nima Kokabi
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Jonah M. Adler
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Anant D. Bhave
2   Division of Interventional Radiology, Department of Radiology, University of Vermont Medical Center, Burlington, Vermont
,
Christopher S. Morris
2   Division of Interventional Radiology, Department of Radiology, University of Vermont Medical Center, Burlington, Vermont
,
Wael E. Saad
3   Division of Vascular and Interventional Radiology, Department of Radiology, University of Utah Hospital, Salt Lake City, Utah
,
David S. Majdalany
4   Division of Cardiology, Mayo Clinic, Scottsdale, Arizona
,
Bill S. Majdalany
2   Division of Interventional Radiology, Department of Radiology, University of Vermont Medical Center, Burlington, Vermont
› Author Affiliations
Funding No funding was received for the development of this manuscript.
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Transjugular intrahepatic portosystemic shunts (TIPS) are widely performed and have replaced more invasive surgical shunt alternatives in the treatment of medically and endoscopically refractory portal hypertensive variceal bleeds and ascites.[1] [2] In the setting of refractory gastroesophageal variceal hemorrhage, creation of a TIPS to decompress the portal system is often combined with variceal embolization to directly treat the source of hemorrhage and decrease rebleed rates.[3] While coil or plug embolization is performed to interrupt flow into the variceal circuit, the addition of sclerotherapy to permeate through and eliminate the variceal circuit has been suggested as a more efficacious therapy with lower rebleed rates.[4] [5] [6] Controlling the distribution of sclerosants in a high-flow system that may have large capacitance and multiple inflow vessels, however, may result in incomplete treatment and the potential for non-target embolization. Herein, a case of TIPS creation and variceal sclerotherapy complicated by paradoxical cerebral embolization is reported followed by a review of the pertinent literature.

Disclosures

No relevant financial disclosures.


N.K.: Research Grant and Proctor, Sirtex Medical.


B.S.M.: Scientific Advisory Board, Balt Medical.


Authors' Contribution

All authors have read and contributed to this manuscript.




Publication History

Article published online:
10 July 2024

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