title: Transjugular intrahepatic portosystemic shunt does not alter cerebral blood flow.
abstract: OBJECTIVE
  Cirrhosis patients with symptomatic portal hypertension might be effectively treated with a transjugular intrahepatic portosystemic shunt stent (TIPS). The intervention, however, carries a risk of debilitating portosystemic hepatic encephalopathy (HE). HE in cirrhosis might be associated with decreased cerebral blood flow (CBF), and CBF might decrease after TIPS.
  
  
  METHODS
  We measured CBF by [(15)O]-water positron emission tomography (PET) in 9 nonencephalopathic cirrhosis patients before and median 11 days after the insertion of TIPS. The PET images were co-registered to magnetic resonance images for region-based analysis.
  
  
  RESULTS
  Pre-TIPS whole-brain CBF varied markedly from very low to high-normal values of 0.28-0.58 mL blood/mL of brain tissue/min. There were no systematic changes in whole-brain or regional CBF after the TIPS treatment (P > .1). No patient had HE after TIPS.
  
  
  CONCLUSIONS
  Treating portal hypertension by TIPS in patients with advanced cirrhosis and without HE had no effect on their CBF and seemed not to entail a risk of cerebral hypoperfusion.
authors.affiliation: Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark. piv@pet.auh.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Iversen
authors.forename: Susanne
authors.initials: S
authors.lastname: Keiding
authors.forename: Kim
authors.initials: K
authors.lastname: Mouridsen
authors.forename: Peter
authors.initials: P
authors.lastname: Ott
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
mesh_terms: D001921:Brain / Q000502:physiology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D012039:Regional Blood Flow / Q000502:physiology*