Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis

BACKGROUND Portal vein thrombosis(PVT)was previously a contraindication for trans-jugular intrahepatic portosystemic shunt(TIPS).AIM To perform a systematic review and meta-analysis of the current available studies investigating outcomes of TIPS for cirrhotic patient with PVT.METHODS Multiple databases were systematically searched to identify studies investigating the outcomes of TIPS for cirrhotic patients with PVT.The quality of studies was assessed by Cochrane Collaboration method and Methodological Index for Non-Randomized Studies.The demographic data,outcomes,combined treatment,and anticoagulation strategy were extracted.RESULTS Twelve studies were identified with 460 patients enrolled in the analysis.The technical success rate was 98.9%in patients without portal vein cavernous transformation and 92.3%in patients with portal vein cavernous transformation.One-year portal vein recanalization rate was 77.7%,and TIPS patency rate was 84.2%.The cumulative encephalopathy rate was 16.4%.One-year overall survival was 87.4%.CONCLUSION TIPS is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with PVT.Cavernous transfor-mation is an indicator for technical failure.Post-TIPS anticoagulation seems not mandatory.Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications,but further investigation is still needed.

Acute carotid stent thrombosis:A case report and literature review

BACKGROUND Acute carotid stent thrombosis(ACST)is a rare but devastating complication in the carotid artery stenting(CAS)procedure.The aim of this article is to report a case and review cases of ACST reported in the literature,and investigate risk factors and management strategies for ACST.CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS.Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020.The demographic data,risk factors,treatment strategies,and prognosis were extracted and analyzed.CONCLUSION The reason for ACST is multifactorial.Proper patient selection,normative antiplatelet treatment,and perfect technical detail may decrease the incidence of ACST.Several treatment strategies such as thrombolysis,mechanical thrombectomy,and open surgery may be options for the treatment of ACST.Limited data have shown that carotid endarterectomy is effective with favorable results.