Transjugular intrahepatic portosystemic shunts (TIPS) are widely used in the management of bleeding gastric varices (GV). More recently, several studies have demonstrated balloon-occluded retrograde transvenous obliteration (BRTO) as an effective treatment method for bleeding isolated GV, especially in patients with contraindications for a TIPS placement. Both TIPS and BRTO can effectively treat bleeding GV with low rebleeding rates. Careful patient selection for TIPS and BRTO procedures is required to best treat the patient's individual clinical situation.
Balloon Occlusion ; Embolization, Therapeutic ; Esophageal and Gastric Varices* ; Hemorrhage ; Humans ; Methods ; Patient Selection ; Portasystemic Shunt, Surgical* ; Portasystemic Shunt, Transjugular Intrahepatic

The technique of balloon-assisted tracking (BAT) has been demonstrated in transradialcardio-angiographic procedures. Using three commonly encountered clinicalscenarios, we outline the technical details of BAT for managing peripheral and cerebralinterventions with challenging vascular access. We describe methods used toovercome vasospasm, stenosis and vascular shelves during interventions for acuteischemic stroke, but these issues are not unique to neuroendovascular cases and thetechniques can be applied across all endovascular interventions. We present threeacute stroke interventions where anatomic challenges were overcome with the useof endovascular BAT. This article describes a novel application for BAT techniques inendovascular interventions to assist with access in peripheral, cervical and intracranialvessels. These methods can also be used to improve access during diagnosticcerebral angiography. BAT is a useful adjunct when navigating catheters throughvasospasm, tortuous anatomy, vascular step-offs or intraluminal plaques.