Response to: Passive Stent Expansion as a Confounder in Under‐Dilated TIPS Outcomes

We read with great interest the comments by Sasidharan et al. [1] and welcome the opportunity to clarify our findings. In our view, evidence supporting spontaneous passive expansion of under-dilated transjugular intrahepatic portosystemic shunts (U-TIPS) remains weak due to study design, sample size and degree of under-dilation. Gaba et al. assessed cross-sectional diameter at the intraparenchymal tract; however, the portal and hepatic vein walls (PVW and HVW) are the most resistant segments. Pieper et al., although including these regions, studied a limited cohort with a less aggressive under-dilation strategy [2]. In contrast, our seminal study assessed the maximum inner diameter across high-resistance segments in a large cohort, observing no significant self-expansion at the PVW or HVW levels [3].