BACKGROUND Glucocorticoids (GC) are a potential therapy for acute liver failure (ALF). However, their clinical efficacy remains controversial, with significant interpatient heterogeneity. AIM To assess the impact of GC therapy on 28-day survival of patients with ALF and identify early treatment-response factors. METHODS In this single-centre retrospective cohort study, 179 patients with ALF from the past 12 years were included: 84 received GC treatment, and 95 served as non-GC controls. The primary outcome was 28-day survival. GC-treated patients were further stratified into responders and nonresponders to analyse the determinants of efficacy. Survival distributions were compared using Kaplan-Meier curves with the log-rank test. Independent predictors of GC response were identified through multivariate logistic regression. Statistical significance was set at P < 0.05. RESULTS The 28-day survival rate was significantly greater in the GC group than in the control group (58.3% vs 30.5%, P < 0.001). An early increase in prothrombin activity (PTA >= 4.5% by day 3), along with baseline model for end-stage liver disease (MELD) score < 28.5 and blood ammonia concentration < 135.5 mu g/dL, was independently associated with GC response. A model combining these factors predicted GC responsiveness with an accuracy of 95.2%. CONCLUSION GC therapy improves 28-day ALF survival. An early increase in the PTA, combined with baseline MELD score and blood ammonia level, effectively identifies patients who are most likely to benefit.

Liver cirrhosis is a leading cause of global liver-related morbidity and mortality, with hepatocellular carcinoma (HCC) being the most common and fatal complication. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive treatment for ascites and gastrointestinal bleeding in patients with cirrhosis. Whether transjugular intrahepatic portalsystemic shunt (TIPS) increases the incidence of hepatocellular carcinoma (HCC) in patients with cirrhosis remains controversial. This study aimed to explore the association between TIPS and the development of HCC. We systematically researched PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until March 7, 2023, to identify eligible studies. The incidence of HCC was extracted and analyzed using a random-effects in RevMan. The primary outcome was the cumulative incidence of HCC, and secondary outcomes included subgroup HCC risk by etiology, stent type, follow-up duration, and overall survival. This study was registered with PROSPERO (CRD42023442262). Ten studies comprising 2753 patients were included. Among the 1070 patients who received TIPS, 11.31

Introduction and Objectives Hepatic encephalopathy (HE) is a major complication after transjugular intrahepatic portal shunt (TIPS), affecting patients’ quality of life. This study evaluated the efficacy of Clostridium butyricum combined with lactulose in preventing HE after TIPS. Patients and Methods Patients were randomly divided into two groups: Clostridium butyricum plus lactulose group (trial group) and lactulose group (control group). Prophylaxis started within 24 hours post-TIPS and lasted 3 months. The primary endpoint was the occurrence of HE at 1 and 3 months after TIPS. The study also analyzed the impact on gut microbiota. Results No significant difference in minimal hepatic encephalopathy (MHE) incidence between the two groups. However, the trial group had a significantly lower overt hepatic encephalopathy (OHE) incidence than the control group at both one month (8.2% vs. 26.5%, P=0.016) and three months (10.2% vs. 34.7%, P=0.004) (HR=3.867, P=0.008; aHR=4.819, P=0.004). The trial group showed a higher skeletal muscle index at the third lumbar vertebra at 3 months after TIPS (42.85 ± 10.66 vs. 38.38 ± 8.61 cm²/m², P=0.024). Combining treatment can reduce the occurrence of OHE in patients with sarcopenia (48.3% vs. 15%, P=0.016). The abundance of butyrate-producing bacteria and the level of butyric acid in the trial group at 3 months after TIPS was significantly increased compared to the baseline. The levels of TNF-α and D-LDH in the trial group were significantly lower than those in the control group at 3 months after TIPS. Conclusions Clostridium butyricum plus lactulose can significantly reduce the incidence of OHE after TIPS and improve nutritional status. In addition, combined therapy can also increase the abundance of beneficial bacteria in stool, increase the level of butyric acid in stool, and improve the inflammatory state in patients undergoing TIPS.

Transjugular intrahepatic portosystemic shunt (TIPS) placement alleviates portal hypertension symptoms. Hepatic encephalopathy (HE) is a common complication of TIPS, impacting patient quality of life and the healthcare burden. Post-TIPS HE is associated with portosystemic shunting, elevated blood ammonia levels, and inflammation. Increasing attention has been given to the liver and intestinal circulation in recent years. An imbalance in intestinal microecology plays a role in the occurrence of HE and may be a new target for treatment. This review discusses the causes, diagnosis, and treatment strategies for post-TIPS HE and focuses on exploring treatment strategies and their relationships with the gut microbiota, suggesting an innovative approach to address this complication.

BACKGROUND:Hepatic encephalopathy (HE) is a primary complication following transjugular intrahepatic portosystemic shunt (TIPS), but the utility of pharmacological prophylaxis for HE is unclear. AIM:To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications. METHODS:A thorough literature search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library databases from their inception to November 24, 2024, to collect data regarding HE incidence. The main outcome was HE incidence post-TIPS. A meta-analysis using a random effects model was performed to obtain odds ratios (ORs) and 95% confidence intervals. Statistical analyses were conducted using Stata and RevMan software. RESULTS:This meta-analysis included nine studies with 1140 patients; 647 received pharmacological agents including lactulose, rifaximin, albumin, and l-ornithin-l-aspartate, and 493 did not (controls). (1) In the single-group meta-analysis, the control group had higher short- and long-term HE rates than the drug intervention group. Among patients with and without prior HE, the non-intervention group's HE rates were also higher; (2) Pharmacological prevention post-TIPS significantly reduced HE incidence [OR = 0.59 (0.45, 0.77), P = 0.0001]. Compared with the no prophylaxis, rifaximin reduced the risk of HE after TIPS [OR = 0.52 (0.29, 0.95), P = 0.03], but lactulose did not; (3) In patients without prior HE, pharmacological prevention significantly reduced post-TIPS HE incidence [OR = 0.62 (0.41,0.95), P = 0.03]; and (4) Network meta-analysis showed no significant differences among five prevention strategies. CONCLUSION:The HE incidence after TIPS was relatively high, and the use of drugs after TIPS may reduce the HE incidence. However, research, especially large-scale randomized controlled trials, is still lacking.

BACKGROUND AND OBJECTIVE:Predicting post-operative flow is essential for assessing the risk of adverse events in cerebrovascular stenosis patients following endovascular treatment (EVT). This study aimed to evaluate the accuracy of the CFD simulation model in predicting post-operative velocity, flow and pressure distal to a stenosis, based on cerebrovascular microcirculatory resistance. METHODS:The patient-specific models of the extracranial and intracranial arteries were reconstructed. The cerebrovascular microcirculatory resistance was applied to estimate post-operative blood velocity and flow rates. Pearson correlation and Bland-Altman analyses were used to evaluate the correlation and agreement between CFD calculations and transcranial Doppler (TCD) measurements. RESULTS:There was a strong correlation between CFD- and TCD-based mean velocities (r = 0.7733; P = 0.0002), with volume flow measured by both methods also showing robust correlation (r = 0.8621; P < 0.0001). Additionally, agreement was found between mean velocities determined by CFD simulation and those estimated by TCD (P = 0.2446, mean difference -4.2089; limits of agreement -11.5764 to 3.1586). However, agreement between volume flow from CFD simulations and TCD was less consistent (P = 0.0387, mean difference -0.3272, limits of agreement -0.9276 to 0.2731). CONCLUSIONS:The computational method used in this study enables the prediction of hemodynamic changes and offers valuable support in tailoring treatment strategies for cerebrovascular stenosis lesions.

BACKGROUND The gut microbiome is associated with hepatic encephalopathy (HE), but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent. AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE. METHODS We searched the PubMed, Web of Science, EMBASE, and Cochrane databases using two keywords, HE, and gut microbiome. According to the inclusion and exclusion criteria, suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE. The data were analyzed using RevMan and STATA. RESULTS Seventeen studies were included: (1) A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE [-0.20, 95% confidence interval (CI): -0.28 to -0.13, I2 = 20%]; (2) The relative abundances of Lachnospiraceae (-2.73, 95%CI: -4.58 to -0.87, I2 = 38%) and Ruminococcaceae (-2.93, 95%CI: -4.29 to -1.56, I2 = 0%) in liver cirrhosis patients with HE was significantly lower than those in patients without HE; (3) In patients with HE, Enterococcus , Proteobacteria , Enterococcaceae , and Enterobacteriaceae proportions increased, but Ruminococcaceae , Lachnospiraceae , Prevotellaceae , and Bacteroidetes proportions decreased; (4) Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected; and (5) Differential gut microbiomes may serve as diagnostic and prognostic tools. CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ. Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.

Background and objectives: Chronic liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF) are interconnected hepatic disorders associated with substantial morbidity and mortality. Despite their distinct clinical characteristics, both conditions share common pathogenic pathways that remain inadequately understood. This study aimed to identify shared gene signatures and elucidate underlying molecular mechanisms. Methods: In this study, we employed Weighted Gene Co-Expression Network Analysis to explore transcriptomic data from the Results: Key co-expression modules enriched with genes involved in glycolysis and gluconeogenesis pathways were identified, implicating metabolic dysfunction as a central feature in both conditions. Furthermore, microRNA analysis revealed that hsa-miR-122 and hsa-miR-194 play pivotal roles in regulating these metabolic pathways, potentially contributing to immune dysregulation. Conclusions: Our findings indicate that these shared molecular mechanisms are critical in the progression from LC to ACLF, providing novel insights into potential therapeutic targets for mitigating disease severity and improving clinical outcomes.

Background: The pulsatility index (PI) derived from transcranial Doppler (TCD) assessment may represent the cerebral resistance and altered cerebral blood flow. The purpose of this study was to assess the performance of the TCD PI in correlation with wire-based fractional pressure ratio (FPR).Methods: This study included 33 patients with symptomatic atherosclerotic lesions of the extracranial and intracranial large arteries, specifically the internal carotid artery, middle cerebral artery (MCA), vertebral artery (VA) V4 segment, and basilar artery (BA), all of which exhibited luminal stenosis ranging from 50% to 70%. TCD was performed prior to angiography in order to determine the flow distal to the lesion. We performed cerebrovascular angiography with a pressure wire to measure the FPR of vessels with stenotic lesions. Bland-Altman analysis and ordinal least square (OLS) linear regression were used to quantify the correlation between PI and FPR.Results: A total of 42 TCD data points were analyzed. At the TCD locations distal to the lesions, the correlation coefficients were no less than 0.90%, with almost all P values <0.001, which indicated very strong positive correlations; the exception to this was the distal TCD for MCA segment lesions (r=0.897; P=0.015) and VA V4 segment (r=0.964; P=0.036). The Bland-Altman plot demonstrated a small difference (0.003) between the distal TCD PI and the FPR, with an acceptable 95% confidence interval (95% CI: 0.06-0.12).Conclusions: The PI obtained through TCD assessment distal to the stenotic lesion exhibited a correlation with the FPR computed using pressure wire measurements.

BackgroundSarcopenia is common in patients with liver cirrhosis and is an independent predictor of multiple clinical outcomes. Most studies to date have used a static assessment of sarcopenia. However, there is very limited data evaluating the temporal course of muscle area in cirrhosis. To bridge this gap in clinical studies, we performed a longitudinal analysis to evaluate the impact of changes in sarcopenia for cirrhotic patients.MethodsAdult patients with clinically diagnosed liver cirrhosis who underwent at least 2 abdominal computed tomography (CT) scans in the hospital were enrolled. The interval between the two abdominal scans was 6 ± 1 months. Patients were categorized into persistent non-sarcopenia, new-onset sarcopenia, sarcopenia to non-sarcopenia, and persistent sarcopenia based on changes in sarcopenia. Kaplan–Meier method and Log-rank tests were used to separately compare unadjusted survival curves by different statuses of sarcopenia. Cox regression analysis was performed to assess the associations between different states of sarcopenia and overall mortality. The association between persistent non-sarcopenia and new-onset sarcopenia was analyzed by multivariate logistic regression analysis.ResultsA total of 307 patients were included for analysis. At the second assessment, 10.10% (31/307) patients were new-onset sarcopenia, 27.69% (85/307) with persistent sarcopenia status, while 13.03% (40/307) patients with sarcopenia developed non-sarcopenia and 49.19% (151/307) with persistent non-sarcopenia status. The overall survival rate was significantly lower in the persistent sarcopenia and new-onset sarcopenia than in the non-sarcopenia group and sarcopenia to non-sarcopenia group (p < 0.001). Persistent sarcopenia (HR 5.799, 95%CI 1.563–21.521, p = 0.009) and new onset sarcopenia (HR 5.205, 95%CI 1.482–18.282, p = 0.010) were identified as poor prognostic factors for cirrhotic patients. The etiology of cirrhosis and the initial skeletal muscle mass were independent risk factors for new-onset sarcopenia.ConclusionSarcopenia is a dynamically changing process in patients with cirrhosis. Persistent and new-onset sarcopenia were independently and robustly associated with overall survival.

BACKGROUND:The prevalence of sarcopenia in patients undergoing liver transplantation (LT) remains to be determined partly because of different diagnostic criteria. Sarcopenia has recently been recognized as a new prognostic factor for predicting outcomes in LT candidates. AIM:To estimate the prevalence of sarcopenia and evaluate its clinical effect on LT candidates. METHODS:This systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library for original English-language articles that investigated the prevalence and influence of sarcopenia in patients undergoing LT from database inception to November 30, 2022. Cohort studies of the definition of sarcopenia that estimate sarcopenia prevalence and evaluate its effect on clinical outcomes and the risk of mortality were included. RESULTS:Twenty-five studies involving 7760 patients undergoing LT were included. The pooled prevalence of sarcopenia in patients undergoing LT was 40.7% [95% confidence intervals (95%CI): 32.1-49.6]. The 1-, 3-, and 5-year cumulative probabilities of post-LT survival in patients with preoperative sarcopenia were all lower than those without sarcopenia (P < 0.05). Sarcopenia was associated with an increased risk of post-LT mortality in patients undergoing LT (adjusted hazard ratio: 1.58; 95%CI: 1.21-2.07). Patients with preoperative sarcopenia had a longer intensive care unit stay, a high risk ratio of sepsis, and serious post-LT complications than those without sarcopenia. CONCLUSION:Sarcopenia is prevalent in a substantial proportion of patients undergoing LT and is strongly and independently associated with higher a risk of mortality risk.

The authors regret they need to change Fig.1 image A∼H to Fig 3 but no change in the figure legends, Fig. 2 image A∼C to Fig. 1 but no change in the figure legends, Fig. 3 image A∼C to Fig. 2 but no change in the figure legends. The order of the figures and figure legends were right, but the images were wrong. The authors would like to apologise for any inconvenience caused. Diagnostic feasibility of middle cerebral artery stenosis or occlusion evaluated by TCCS and CEUS: Repeatability, reproducibility, and diagnostic agreement with DSAJournal of Stroke and Cerebrovascular DiseasesVol. 33Issue 3PreviewThis study aimed to evaluate the feasibility of transcranial color-coded sonography (TCCS) and contrast-enhanced ultrasound (CEUS) in assessing middle cerebral artery (MCA) stem stenosis or occlusion compared to digital subtraction angiography (DSA). Full-Text PDF

Background::The Global Leadership Initiative on Malnutrition (GLIM) criteria were published to build a global consensus on nutritional diagnosis. Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria. However, there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings. This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition, as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.Methods::This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1, 2018, and February 28, 2022, at Beijing You-An Hospital, Capital Medical University. Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography (CT) examination during hospitalization were included in the study. These patients were randomly divided into a modeling group (cohort 1, 667 patients) and a validation group (cohort 2, 335 patients). In cohort 1, optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index (L3-SMI) were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups. Next, patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. Additionally, the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1. Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.Results::The optimal cut-off values of L3-SMI were 39.50 cm 2/m 2 for male patients and 33.06 cm 2/m 2 for female patients. Based on the cut-off values, 31.63% (68/215) of the male patients and 23.3% (28/120) of the female patients had CT-determined sarcopenia in cohort 2. The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3% (115/335) and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis ( Wald = 6.347, P = 0.012). Conclusions::This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis. These reference values will contribute to applying the GLIM criteria in cirrhotic patients.

This patient was an elderly patient with abdominal distension and shortness of breath. According to relevant examinations, his condition was initially considered to be related to cirrhosis, but pathological biopsy confirmed the diagnosis of noncirrhotic portal hypertension of unknown etiology. The portal vein pressure was significantly reduced after transjugular intrahepatic portosystemic shunt (TIPS). Nevertheless, the relief of the hydrothorax and ascites was not significant, and the numbness in both lower limbs gradually worsened. POEMS syndrome was ultimately diagnosed following a comprehensive examination. After two courses of bortezomib combined with dexamethasone, the patient died due to a systemic infection. The clinical symptoms of the patient were atypical, as was the presence of portal hypertension, which hindered the diagnosis of POEMS. Due to the patient’s advanced age, the diagnosis was delayed, and the prognosis was poor. This case reminds clinicians that POEMS patients can also have portal hypertension as the main manifestation.

Aim: This study aimed to evaluate the feasibility of transcranial color-coded sonography (TCCS) and contrast-enhanced ultrasound (CEUS) in assessing middle cerebral artery (MCA) stem stenosis or occlusion compared to digital subtraction angiography (DSA). Methods: A total of 48 cases including 96 MCAs suspected stem stenosis or obstruction in the MCA were assessed by TCCS, CE-TCCS, and DSA. The diameters of the most severe stenosis (Ds), proximal normal artery (Dn), and diameter stenosis rate of MCA were measured using both the color doppler flow imaging (CDFI) modality of TCCS or CEUS and the CEUS imaging modality. The intraclass correlation coefficients (ICCs) and 95 % confidence intervals (CI) were evaluated, and a weighted Kappa value was used to evaluate the intra-observer agreement, inter-observer agreement, agreement between CDFI modality and DSA stenosis or occlusion, and agreement between CEUS imaging modality and DSA stenosis or occlusion. Results: The ICC results indicated excellent repeatability and reproducibility (all ICCs > 0.75; weighted Kappa values >0.81). Compared with DSA, the weighted Kappa values and 95 % CIs of stenosis (the first measurement was taken by two observers) of CDFI modality and CEUS imaging modality were 0.175 (0.041, 0.308) and 0.779 (0.570, 0.988) for observers A and 0.181 (0.046, 0.316) and 0.779 (0.570, 0.988) for observers B respectively. Conclusion: This study indicates that inter- and intra-observer agreements were good for the direct method of measuring percentages of MCA stenosis by TCCS and CEUS. CEUS imaging modality is a new and reliable imaging modality approach to evaluate the MCAs stenosis and occlusion.

This study aimed to evaluate cardiac function, particularly left ventricular systolic function, in patients with Parkinson disease (PD) using velocity vector imaging (VVI), and to determine whether a correlation exists between left ventricular global systolic function and PD severity.

Background and objective: The non-invasive assessment of microcirculatory resistance could improve the treatment of cerebrovascular stenosis. This study aimed to validate a novel computational strategy for determining the reference value of microcirculatory resistance in patients with cerebrovascular stenosis.Methods: We reconstructed a patient-specific 3-dimensional model of the extracranial-intracranial arter-ies. A computational strategy incorporating patient-specific pressure-wire measurements was developed to estimate the blood flow rate and microcirculatory resistance. Throughout the computational fluid dy-namics (CFD) simulation, the boundary conditions were adjusted according to the developed algorithm. Pearson correlation and Bland-Altman analyses were used to quantify the correlation and agreement be-tween CFD calculations and transcranial Doppler (TCD) assessment. Results: A strong correlation was found between the CFD-based and invasive distal pressure mea-surements ( P < 0.0 0 01). Meanwhile, the CFD and TCD-based flow measurements were highly correlated ( r = 0.853; P = 0.001). Furthermore, there was a correlation between the mean velocity measured by CFD and the mean velocity measured by TCD ( r = 0.777; P < 0.001). Good agreement was observed be-tween the mass flow by CFD simulation and volumetric flow by TCD ( P = 0.0266, mean difference: -0.7814 mmHg, limits of agreement,-4.0905 -2.5276). However, the mean velocities from CFD simulation were in less agreement with those from the TCD assessment ( P = 0.3992, mean difference,-0.0485; lim-its of agreement,-0.6141 -0.5170). Results of the CFD simulation indicate that the flow resistance varies greatly between individuals. Conclusions: The computational strategy of incorporating patient-specific pressure-wire measurements may serve as an effective approach to evaluate the actual reference values of microcirculatory resistance. In addition, an individualized assessment of non-invasive flow resistance is necessary for the accurate determination of non-invasive cerebrovascular pressure.(c) 2023 Elsevier B.V. All rights reserved.

-OBJECTIVE: We aimed to evaluate the performance of fast and straightforward Murray law-based quantitative flow ratio (mu QFR) computation in cerebrovascular stenosis.-METHODS: A total of 30 patients with symptomatic stenosis of 50%-70% luminal stenosis and underwent fractional pressure ratio (FPR) assessment at our hospital were included in the present study. mu QFR was applied to the interrogated vessel. An artificial intelligence algorithm was proposed for automatic delineation of lumen contours of cerebrovascular stenosis. We used invasive FPRs as a reference standard. Pearson's correlation coefficient (r) was used to assess the correlation strength between the mu QFR and FPR, and Bland-Altman plots were used to evaluate the agreement between the mu QFR and FPR. An analysis of the receiver operating characteristic was used to evaluate the performance of mu QFR.-RESULTS: Our results displayed a strong positive correlations (r = 0.92; P < 0.001) between the mu QFR and pressure wire FPR. Excellent agreement was observed between the mu QFR and FPR with a mean difference of 0.01 +/- 0.08 (range, L0.16 to 0.14; P = 0.263). The overall accuracy for identifying an FPR of <= 0.7 was 92% (95% confidence interval [CI], 85%-100%). The area under the receiver operating characteristic curve was higher for the mu QFR (0.92; 95% CI, 0.81-0.98) than for diameter stenosis (0.88; 95% CI, 0.75-0.95). The positive likelihood ratio was 3.9 for the mu QFR with a negative likelihood ratio of 0.-CONCLUSIONS: The mu QFR computation has a strong correlation and agrees with the FPR calculated from the pressure wire. Therefore, the mu QFR might provide an essential therapeutic aid for patients with symptomatic stenosis.

Background:Hyperperfusion syndrome (HPS) is a serious complication after stent implantation in symptomatic intracranial atherosclerotic stenosis (ICAS). This study aims to explore the predictive value of preprocedural computed tomography perfusion (CTP) for HPS after intracranial stenting.Methods:In this retrospective case-control study we collected data from consecutive patients from June 2012 to September 2019 who underwent stent implantation due to severe symptomatic ICAS. Patients who underwent CTP before the procedure were enrolled. CTP was postprocessed using the automated RAPID software to assess the preoperative cerebral perfusion. According to the presence or absence of HPS, the patients were classified into two groups: the HPS group and the non-HPS group. The baseline data, lesion characteristics, and preoperative CTP parameters between the two groups were compared. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal predictor of HPS.Results:Among the 170 eligible patients, 6 patients (3.53%) had HPS, including 3 who presented with intracranial hemorrhages (ICHs), 1 who had dysphoria, 1 who had delirium, and 1 who had a headache. There were no significant differences in baseline and lesion characteristics between the HPS and non-HPS groups. Compared with the non-HPS group, the HPS group had a significantly higher volume of time-to-maximum (Tmax) >4 s (429.5 vs. 93 mL; P=0.006) and Tmax >6 s (200 vs. 0 mL; P=0.003). The optimal volume threshold for maximizing sensitivity in predicting HPS was 65.5 mL with Tmax >4 s [area under the curve (AUC), 0.832; 95% confidence interval (CI): 0.650 to 1.000; P=0.006].Conclusions:Tmax >4 s volume may be a predictor of HPS after stent implantation in symptomatic ICAS. Further prospective studies should be conducted to confirm our conclusion.

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective way to improve portal hypertension, however, the role of anticoagulation or antiplatelet therapy following TIPS remains controversial. We conducted this study to evaluate the efficacy and safety of anticoagulation or antiplatelet therapy following TIPS. Methods: A literature search was conducted on anticoagulation or antiplatelet therapy after TIPS using Pubmed, Web of Science, EMBASE, and Cochrane. The retrieval period was from the earliest accessible date in the database to 31 October 2022. We collected information on the incidence of stent dysfunction, bleeding, hepatic encephalopathy, the new occurrence of portal vein thrombosis, and the survival rate. Stata was analyzed in RevMan. Results: 1. Four studies received anticoagulation or antiplatelet therapy after TIPS without control groups. According to the single-group rate meta-analysis, stent dysfunction occurred at 27% [95% CI (0.19, 0.38)], bleeding occurred at 21% [95% CI (0.14, 0.29)], new portal vein thrombosis occurred at 17% [(95%CI(0.04.0.71)], hepatic encephalopathy occurred at 47% [95%CI (0.34, 0.63)], and death occurred at 31% [95% CI (0.22, 0.42)]. 2. Eight studies, including 1025 patients, compared anticoagulation and antiplatelet therapy after TIPS to TIPS alone. In terms of stent dysfunction, bleeding, and hepatic encephalopathy, there were no significant differences between the two groups. The use of anticoagulation or antiplatelet therapy may result in a significant decrease in the incidence of new portal vein thrombosis and mortality over 1 year. Discussion: Anticoagulant or antiplatelet therapy may not improve the patency rate of TIPS, but may effectively prevent new portal vein thrombosis after TIPS. Following TIPS, the use of anticoagulants or antiplatelet drugs does not lead to an increase in bleeding or death.