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

Amar Mukund; Tanya Yadav; Satender Pal Singh; Saggere Muralikrishna Shasthry; Rakhi Maiwall; Yashwant Patidar; Shiv Kumar Sarin

doi:10.1055/s-0043-1770343

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

Indian J Radiol Imaging. 2023 Jun 26;34(1):25-31. doi: 10.1055/s-0043-1770343. eCollection 2024 Jan.

Authors

Amar Mukund¹, Tanya Yadav¹, Satender Pal Singh², Saggere Muralikrishna Shasthry², Rakhi Maiwall², Yashwant Patidar¹, Shiv Kumar Sarin²

Affiliations

¹ Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
² Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

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]x10 ⁵ IU versus [8.3 ± 2.9]x10 ⁵ 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: Budd-Chiari syndrome; catheter-directed thrombolysis; direct intrahepatic portosystemic shunt; thrombolysis.

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Grants and funding

Funding None.