Mechanical thrombectomy of acute thrombosis in transjugular intrahepatic portosystemic shunts

RATIONALE AND OBJECTIVES. To evaluate the feasibility of mechanical thrombe ctomy with the use of the Amplatz thrombectomy device (ATD) in restoring pa tency to acutely thrombosed stent-shunts after transjugular intrahepatic po rtosystemic shunt (TIPS) placement. METHODS. Mechanical thrombectomy with the ATD was performed in 10 consecuti ve patients with angiographically documented complete thrombosis of the ste nt-shunt (mean +/- SD, 6.6 +/- 3.4 cm), which occurred an average of 2.8 mo nths (range, 0-11 months) after the TIPS procedure. RESULTS. In all patients, immediate restoration of patency of the stent-shu nt was achieved after thrombectomy alone (n = 1), thrombectomy plus percuta neous transluminal angioplasty (PTA; n = 4), and thrombectomy, PTA, and ste nting (n = 5), The mean activation time of the ATD was 253 +/- 43 seconds. The pressure gradient for portal decompression decreased from 23 +/- 6 mmHg before to 11 +/- 3 mmHg after the procedure. The primary patency rate was 80% at 3 months and 60% at 11 months. CONCLUSIONS. Mechanical thrombectomy with the ATD in acutely thrombosed TIP S is technically feasible, Mechanical thrombectomy is a potential alternati ve to thrombolysis.