This study aimed to investigate the efficacy and safety of drug eluting beads transarterial chemoembolization (DEB-TACE) treatment by CalliSpheres® in Chinese patients with hepatocellular carcinoma (HCC) as well as the predicting factors for response. 99 patients with HCC were consecutively enrolled in this study. All participants were treated by CalliSpheres® DEB-TACE. Clinical response was evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Common Terminology Criteria for Adverse Events (CTCAE) was used to assess the adverse events and liver dysfunction during and after the operation. Post treatment, 16 patients (16.2%) achieved CR and 59 (59.6%) achieved PR, the ORR was 75.8%. Subgroup analysis showed that patients with higher BCLC stage were of worse CR and ORR rates, and the CR as well as ORR between patients with cTACE history and patients without cTACE history were similar. Univariate logistic regression analysis displayed that number of nodules > 3, higher BCLC stage and previous cTACE might be correlated with worse ORR but with no statistical significance. As to liver function, CTCAE grades of laboratory indexes for liver function were increased at 1 week compared to baseline and recovered to the baseline grades at 1–3 months post operation. Besides, most of the common adverse events were light and moderate in our study. In conclusion, DEB-TACE by CalliSpheres® was efficient and well tolerated in Chinese HCC patients, and BCLC stage, number of nodules and cTACE history were possibly correlated with treatment response.

Background: Drug-eluting bead transarterial chemoembolization (DEB-TACE) has shown efficacy for treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, whether DEB-TACE is superior to conventional TACE (cTACE) remains unclear. Objective: This randomized controlled trial aimed to compare the efficacy and safety of DEB-TACE versus cTACE in treating HCC with PVTT. Methods: The study was conducted at a tertiary care center in Southeast China. HCC patients with PVTT were randomized at a 1:1 ratio into the DEB-TACE or cTACE groups. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival (OS) and the incidence of adverse events (AEs). An independent review committee assessed the radiologic response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). AEs were assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Systemic therapies were not restricted. Results: Between September 2018 and July 2020, 163 patients were randomized to undergo DEB-TACE (n=82) or cTACE (n=81). Nine patients were excluded, and 154 patients were included in the final analysis; the median age was 55 years (range, 24–78 years), and 140 (90.9%) were male. The median PFS in the DEB-TACE group was 6.0 months (95% CI, 5.0–10.0) versus 4.0 months (95% CI, 3.0–5.0) in the cTACE group (hazard ratio, 0.63; 95% CI, 0.42–0.95; P=0.027). The DEB-TACE group showed a higher response rate [51 (66.2%) vs. 36 (46.8%); P=0.0015] and a longer median OS [12.0 months (95% CI, 9.0–16.0) vs. 8.0 months (95% CI, 7.0–11.0), P=0.039] than the cTACE group. Multivariate analysis showed that the treatment group, ALBI score, distant metastasis and additional TKIs were the four independent prognostic factors correlated with PFS. In addition, the treatment group, PVTT group and combination with surgery were independently associated with OS. AEs were similar in the two groups, and postembolization syndrome was the most frequent AE. Conclusion: DEB-TACE is superior to cTACE in treating HCC patients with PVTT, demonstrating improved PFS and OS with an acceptable safety profile, and may thus emerge as a promising treatment strategy for HCC patients with PVTT. Trial registration: Chinese Clinical Trial Registry ChiCTR1800018035.

BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a highly effective treatment for complications associated with portal hypertension. However, stent fracture, although extremely rare, represents a potentially serious complication following TIPS creation. Timely identification and management are crucial for preventing further adverse events. CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for recurrent melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure. He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites. An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful. Consequently, a parallel TIPS procedure was successfully performed via the proximal end of the fractured stent to decompress the portal venous system. At the 1-month follow-up, the patient exhibited no recurrent variceal bleeding, and his ascites had significantly decreased. Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites. Additionally, we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this complication. CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.

Portal vein (PV) tear is an uncommon yet potentially fatal complication associated with balloon angioplasty, particularly when treating PV stenosis caused by tumor invasion and compression. This paper presents the case of a 66-year-old male with advanced perihilar cholangiocarcinoma who experienced a PV tear during a bare-metal stent implantation and balloon angioplasty for PV stenosis induced by tumor invasion. Emergency covered stent implantation effectively manages life-threatening intra-abdominal hemorrhage, leading to successful recovery. This case highlights the importance of recognizing PV tears as complications in patients undergoing balloon angioplasty and underscores the efficacy of emergency covered stent implantation in managing such cases. Additionally, this study contributes to the literature by discussing the management strategies and outcomes associated with PV tears during balloon angioplasty.

To evaluate the efficacy and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in treating pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). We conducted a retrospective analysis of patients diagnosed with severe PA-HSOS at our institution between January 2016 and October 2025. Baseline clinical characteristics and follow-up data were extracted from medical records. All included patients had failed prior conventional medical therapy. A total of 125 patients diagnosed with HSOS was screened and 33 patients ultimately included in this study, of whom 17 were male. Clinical presentations comprised ascites in 31 patients, and variceal bleeding in 2 patients. During a median follow-up of 42 months (ranging from 2 to 118 months), there were four deaths, only one related to liver failure. The overall survival rates at 1, 3 and 5 years were 93.8%, 90.3% and 82.1%, respectively. Clinical improvement was observed in most patients, with ascites resolving in 31 patients one month after the procedure, and the hepatic vein was clearly displayed on post-TIPS imaging in 26 patients, confirming successful shunt patency. Notably, no cases of overt hepatic encephalopathy were observed during the follow-up period. TIPS is associated with favorable clinical and survival outcomes in patients with PA-HSOS refractory to medical management, and represents a viable therapeutic alternative for this condition.