Percutaneous Cystic Duct Interventions and Drain Internalization for Calculous Cholecystitis in Patients Ineligible for Surgery.

PURPOSE: To evaluate the feasibility, effectiveness, and outcomes of percutaneous cholecystostomy drain internalization in patients with calculous cholecystitis who were not surgical candidates. MATERIALS AND METHODS: Percutaneous cystic duct interventions were attempted in 17 patients (with the intent to place dual cholecystoduodenal stents) who were deemed unfit for surgery and had previously undergone percutaneous cholecystostomies for acute calculous cholecystitis. Baseline demographics, technical success, time from percutaneous cholecystostomy to internalization (dual cholecystoduodenal stent placement), stent patency duration, and adverse event rates were evaluated. RESULTS: Fifteen (88%) of 17 procedures to cross the cystic duct were technically successful. Of these 17 patients, 13 (76%) underwent successful placement of dual cholecystoduodenal stents. Two of these 13 patients (who had successful dual cholecystoduodenal stent placement) needed repeat percutaneous cholecystostomy drains (1 patient had stent migration leading to recurrent cholecystitis, and the other had a perihepatic biloma). The 1-year patency rate was 77% (95% CI, 47%-100%). CONCLUSIONS: Dual cholecystoduodenal stent placement in nonsurgical patients is a technically feasible treatment option with the goal to remove percutaneous cholecystostomy drains.

PKC isoforms activate LRRK1 kinase by phosphorylating conserved residues (Ser1064, Ser1074 and Thr1075) within the CORB GTPase domain.

Leucine-rich-repeat-kinase 1 (LRRK1) and its homolog LRRK2 are multidomain kinases possessing a ROC-CORA-CORB containing GTPase domain and phosphorylate distinct Rab proteins. LRRK1 loss of function mutations cause the bone disorder osteosclerotic metaphyseal dysplasia, whereas LRRK2 missense mutations that enhance kinase activity cause Parkinson's disease. Previous work suggested that LRRK1 but not LRRK2, is activated via a Protein Kinase C (PKC)-dependent mechanism. Here we demonstrate that phosphorylation and activation of LRRK1 in HEK293 cells is blocked by PKC inhibitors including LXS-196 (Darovasertib), a compound that has entered clinical trials. We show multiple PKC isoforms phosphorylate and activate recombinant LRRK1 in a manner reversed by phosphatase treatment. PKCα unexpectedly does not activate LRRK1 by phosphorylating the kinase domain, but instead phosphorylates a cluster of conserved residues (Ser1064, Ser1074 and Thr1075) located within a region of the CORB domain of the GTPase domain. These residues are positioned at the equivalent region of the LRRK2 DK helix reported to stabilize the kinase domain αC-helix in the active conformation. Thr1075 represents an optimal PKC site phosphorylation motif and its mutation to Ala, blocked PKC-mediated activation of LRRK1. A triple Glu mutation of Ser1064/Ser1074/Thr1075 to mimic phosphorylation, enhanced LRRK1 kinase activity ∼3-fold. From analysis of available structures, we postulate that phosphorylation of Ser1064, Ser1074 and Thr1075 activates LRRK1 by promoting interaction and stabilization of the αC-helix on the kinase domain. This study provides new fundamental insights into the mechanism controlling LRRK1 activity and reveals a novel unexpected activation mechanism.

Research Priorities in Percutaneous Image- and Endoscopy-Guided Interventions for Biliary and Gallbladder Diseases: Proceedings from the Society of Interventional Radiology Foundation Multidisciplinary Research Consensus Panel.

Recent technological advancements, including the introduction of disposable endoscopes, have enhanced the role of interventional radiology (IR) in the management of biliary and gallbladder diseases. There are unanswered questions in this growing field. The Society of Interventional Radiology Foundation convened a virtual research consensus panel consisting of a multidisciplinary group of experts to develop a prioritized research agenda regarding percutaneous image- and endoscopy-guided procedures for biliary and gallbladder diseases. The panelists discussed current data, opportunities for IR, and future efforts to maximize IR's ability and scope. A recurring theme throughout the discussions was to find ways to reduce the total duration of percutaneous drains and improve patients' quality of life. After the presentations and discussions, research priorities were ranked on the basis of their clinical relevance and impact. The research ideas ranked top 3 were as follows: (a) percutaneous multimodality management of benign anastomotic biliary strictures (laser vs endobiliary ablation vs cholangioplasty vs drain upsize protocol alone), (b) ablation of intraductal cholangiocarcinoma with and without stent placement, and (c) cholecystoscopy/choledochoscopy and lithotripsy in nonsurgical patients with calculous cholecystitis. Collaborative, retrospective, and prospective research studies are essential to answer these questions and improve the management protocols for patients with biliary and gallbladder diseases.

Impact of Portal Hypertension on Adverse Events after Splenic Arterial Aneurysm Embolization.

PURPOSE: To evaluate the outcomes of splenic artery aneurysm (SAA) embolization and compare adverse event (AE) rates after embolization in patients with and without portal hypertension (PHTN). MATERIALS AND METHODS: A retrospective review of all patients who underwent embolization of SAAs at 2 institutions was performed (34 patients from institution 1 and 7 patients from institution 2). Baseline demographic characteristics, preprocedural imaging, procedural techniques, and postprocedural outcomes were evaluated. Thirty-day postprocedural severe and life-threatening AEs were evaluated using the Society of Interventional Radiology guidelines. Thirty-day mortality and readmission rates were also evaluated. t test, χ2 test, and/or Fisher exact test were used for the statistical analysis. RESULTS: There was no statistically significant difference between patients with and without PHTN in the location, number, and size of SAA(s). All procedures were technically successful. There were 13 (32%) patients with and 28 (68%) patients without PHTN. The 30-day mortality rate (31% vs 0%; P = .007), readmission rates (61% vs 7%; P < .001), and severe/life-threatening AE rates (69% vs 0%; P < .001) were significantly higher in patients with PHTN than in those without PHTN. CONCLUSIONS: There was a significantly higher mortality and severe/life-threatening AE rate in patients with PHTN than in those without PHTN. SAAs in patients with PHTN need to be managed very cautiously, given the risk of severe/life-threatening AEs after embolization.

How Endoscopic Guidance Augments Nonvascular Image-guided Interventions.

Endoscopy can improve guidance in nonvascular procedures performed by interventional radiologists (IRs). Historically, the major limiting factors preventing the widespread use of endoscopic tools by IRs were the large diameter (>20F) and length of the endoscopes. IRs had to significantly upsize their access into vascular organs such as the kidney and liver to allow endoscope placement. With the advent of newer endoscopes with sizes smaller than 11F (approximately 4 mm in diameter), percutaneous endoscopy has become more feasible than before. IRs routinely place percutaneous drains (eg, abscess drains, biliary drains, percutaneous nephrostomies, and percutaneous cholecystostomies). Once the drain is in position and the acute infection (if present) has resolved, the IR can use the percutaneous access to perform image-guided and endoscopically guided procedures, depending on the clinical situation. Most percutaneous image- and endoscopically guided interventions performed by IRs involve procedures for biliary and gallbladder pathologic conditions. Image-guided procedures with additional endoscopic guidance can also be used to manage urinary, gastrointestinal, and gynecologic pathologic conditions. The authors review the current applications and techniques of percutaneous endoscopy in interventional radiology. In unique situations, IRs can also perform endoscopy through natural orifices (eg, the urethra) or surgically created orifices (eg, urostomies). The authors also discuss the adjunctive techniques that are enhanced or made possible because of endoscopy in interventional radiology, including but not limited to endoscopic forceps biopsies, endobiliary ablation, laser stricturotomy, lithotripsy, and stone extraction. An invited commentary by Srinivasa is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Deciphering the LRRK code: LRRK1 and LRRK2 phosphorylate distinct Rab proteins and are regulated by diverse mechanisms.

Autosomal dominant mutations in LRRK2 that enhance kinase activity cause Parkinson's disease. LRRK2 phosphorylates a subset of Rab GTPases including Rab8A and Rab10 within its effector binding motif. Here, we explore whether LRRK1, a less studied homolog of LRRK2 that regulates growth factor receptor trafficking and osteoclast biology might also phosphorylate Rab proteins. Using mass spectrometry, we found that in LRRK1 knock-out cells, phosphorylation of Rab7A at Ser72 was most impacted. This residue lies at the equivalent site targeted by LRRK2 on Rab8A and Rab10. Accordingly, recombinant LRRK1 efficiently phosphorylated Rab7A at Ser72, but not Rab8A or Rab10. Employing a novel phospho-specific antibody, we found that phorbol ester stimulation of mouse embryonic fibroblasts markedly enhanced phosphorylation of Rab7A at Ser72 via LRRK1. We identify two LRRK1 mutations (K746G and I1412T), equivalent to the LRRK2 R1441G and I2020T Parkinson's mutations, that enhance LRRK1 mediated phosphorylation of Rab7A. We demonstrate that two regulators of LRRK2 namely Rab29 and VPS35[D620N], do not influence LRRK1. Widely used LRRK2 inhibitors do not inhibit LRRK1, but we identify a promiscuous inhibitor termed GZD-824 that inhibits both LRRK1 and LRRK2. The PPM1H Rab phosphatase when overexpressed dephosphorylates Rab7A. Finally, the interaction of Rab7A with its effector RILP is not affected by LRRK1 phosphorylation and we observe that maximal stimulation of the TBK1 or PINK1 pathway does not elevate Rab7A phosphorylation. Altogether, these findings reinforce the idea that the LRRK enzymes have evolved as major regulators of Rab biology with distinct substrate specificity.

A novel approach for heart disease prediction using strength scores with significant predictors.

BACKGROUND: Cardiovascular disease is the leading cause of death in many countries. Physicians often diagnose cardiovascular disease based on current clinical tests and previous experience of diagnosing patients with similar symptoms. Patients who suffer from heart disease require quick diagnosis, early treatment and constant observations. To address their needs, many data mining approaches have been used in the past in diagnosing and predicting heart diseases. Previous research was also focused on identifying the significant contributing features to heart disease prediction, however, less importance was given to identifying the strength of these features. METHOD: This paper is motivated by the gap in the literature, thus proposes an algorithm that measures the strength of the significant features that contribute to heart disease prediction. The study is aimed at predicting heart disease based on the scores of significant features using Weighted Associative Rule Mining. RESULTS: A set of important feature scores and rules were identified in diagnosing heart disease and cardiologists were consulted to confirm the validity of these rules. The experiments performed on the UCI open dataset, widely used for heart disease research yielded the highest confidence score of 98% in predicting heart disease. CONCLUSION: This study managed to provide a significant contribution in computing the strength scores with significant predictors in heart disease prediction. From the evaluation results, we obtained important rules and achieved highest confidence score by utilizing the computed strength scores of significant predictors on Weighted Associative Rule Mining in predicting heart disease.

Trajectory Design for UAV-Based Data Collection Using Clustering Model in Smart Farming.

Unmanned aerial vehicles (UAVs) play an important role in facilitating data collection in remote areas due to their remote mobility. The collected data require processing close to the end-user to support delay-sensitive applications. In this paper, we proposed a data collection scheme and scheduling framework for smart farms. We categorized the proposed model into two phases: data collection and data scheduling. In the data collection phase, the IoT sensors are deployed randomly to form a cluster based on their RSSI. The UAV calculates an optimum trajectory in order to gather data from all clusters. The UAV offloads the data to the nearest base station. In the second phase, the BS finds the optimally available fog node based on efficiency, response rate, and availability to send workload for processing. The proposed framework is implemented in OMNeT++ and compared with existing work in terms of energy and network delay.

An EEG study of detection without localisation in change blindness.

Previous studies of change blindness have suggested a distinction between detection and localisation of changes in a visual scene. Using a simple paradigm with an array of coloured squares, the present study aimed to further investigate differences in event-related potentials (ERPs) between trials in which participants could detect the presence of a colour change but not identify the location of the change (sense trials), versus those where participants could both detect and localise the change (localise trials). Individual differences in performance were controlled for by adjusting the difficulty of the task in real time. Behaviourally, reaction times for sense, blind, and false alarm trials were distinguishable when comparing across levels of participant certainty. In the EEG data, we found no significant differences in the visual awareness negativity ERP, contrary to previous findings. In the N2pc range, both awareness conditions (localise and sense) were significantly different to trials with no change detection (blind trials), suggesting that this ERP is not dependent on explicit awareness. Within the late positivity range, all conditions were significantly different. These results suggest that changes can be 'sensed' without knowledge of the location of the changing object, and that participant certainty scores can provide valuable information about the perception of changes in change blindness.

IoT Operating System Based Fuzzy Inference System for Home Energy Management System in Smart Buildings.

Energy consumption in the residential sector is 25% of all the sectors. The advent of smart appliances and intelligent sensors have increased the realization of home energy management systems. Acquiring balance between energy consumption and user comfort is in the spotlight when the performance of the smart home is evaluated. Appliances of heating, ventilation and air conditioning constitute up to 64% of energy consumption in residential buildings. A number of research works have shown that fuzzy logic system integrated with other techniques is used with the main objective of energy consumption minimization. However, user comfort is often sacrificed in these techniques. In this paper, we have proposed a Fuzzy Inference System (FIS) that uses humidity as an additional input parameter in order to maintain the thermostat set-points according to user comfort. Additionally, we have used indoor room temperature variation as a feedback to proposed FIS in order to get the better energy consumption. As the number of rules increase, the task of defining them in FIS becomes time consuming and eventually increases the chance of manual errors. We have also proposed the automatic rule base generation using the combinatorial method. The proposed techniques are evaluated using Mamdani FIS and Sugeno FIS. The proposed method provides a flexible and energy efficient decision-making system that maintains the user thermal comfort with the help of intelligent sensors. The proposed FIS system requires less memory and low processing power along with the use of sensors, making it possible to be used in the IoT operating system e.g., RIOT. Simulation results validate that the proposed technique reduces energy consumption by 28%.

Music-induced emotions can be predicted from a combination of brain activity and acoustic features.

It is widely acknowledged that music can communicate and induce a wide range of emotions in the listener. However, music is a highly-complex audio signal composed of a wide range of complex time- and frequency-varying components. Additionally, music-induced emotions are known to differ greatly between listeners. Therefore, it is not immediately clear what emotions will be induced in a given individual by a piece of music. We attempt to predict the music-induced emotional response in a listener by measuring the activity in the listeners electroencephalogram (EEG). We combine these measures with acoustic descriptors of the music, an approach that allows us to consider music as a complex set of time-varying acoustic features, independently of any specific music theory. Regression models are found which allow us to predict the music-induced emotions of our participants with a correlation between the actual and predicted responses of up to r=0.234,p<0.001. This regression fit suggests that over 20% of the variance of the participant's music induced emotions can be predicted by their neural activity and the properties of the music. Given the large amount of noise, non-stationarity, and non-linearity in both EEG and music, this is an encouraging result. Additionally, the combination of measures of brain activity and acoustic features describing the music played to our participants allows us to predict music-induced emotions with significantly higher accuracies than either feature type alone (p<0.01).

A new prognostic scoring system for perforation peritonitis secondary to duodenal ulcers.

OBJECTIVE: To identify prognostic factors for perforated duodenal ulcers and to devise and assess a new scoring system. METHODS: The observational prospective study was conducted at the Mayo Hospital, Lahore in two phases: from March 2010 to September 2011; and from October 2011 to July 2012. It included patients with duodenal ulcer perforation who were observed for identifying factors predicting 30-day prognosis. Each of the predictive factor was given a score based on its severity to devise a new scoring system. Chi-square was used for univariate analysis. Multivariate analysis was done using forward stepwise regression. Accuracy of the new scoring system was calculated using receiver operating curve analysis and its validity was evaluated in the second phase of the study. RESULTS: Predictors of poor prognosis included multiple gut perforations, size of largest perforation >0.5cm, amount of peritoneal fluid >1000ml, simple closure, development of complications, post-operative systemic septicaemia and winter/autumn season of presentation. Overall 30-day mortality rate was 32.3% (n=32) and morbidity rate was 21.2% (n=21). The mean score was higher in the ones with poor prognosis (p=0.001). Similarly, the mean score was greater in those with grave prognosis (p=0.001). The scoring system had an overall sensitivity of 85.12% and specificity of 80.67% and was favourably comparable to other scoring systems. CONCLUSION: The new scoring system is a useful tool in predicting 30-day prognosis for perforated duodenal ulcers in acid peptic disease.

LSTMDD: an optimized LSTM-based drift detector for concept drift in dynamic cloud computing.

This study aims to investigate the problem of concept drift in cloud computing and emphasizes the importance of early detection for enabling optimum resource utilization and offering an effective solution. The analysis includes synthetic and real-world cloud datasets, stressing the need for appropriate drift detectors tailored to the cloud domain. A modified version of Long Short-Term Memory (LSTM) called the LSTM Drift Detector (LSTMDD) is proposed and compared with other top drift detection techniques using prediction error as the primary evaluation metric. LSTMDD is optimized to improve performance in detecting anomalies in non-Gaussian distributed cloud environments. The experiments show that LSTMDD outperforms other methods for gradual and sudden drift in the cloud domain. The findings suggest that machine learning techniques such as LSTMDD could be a promising approach to addressing the problem of concept drift in cloud computing, leading to more efficient resource allocation and improved performance.

Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study.

PURPOSE: This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures. METHODS: Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g., cholangiography) and therapeutic (e.g., stent/drain insertion and cholangioplasty) purposes. The most common indications for MHLA were biliary strictures (60%) and bile leaks (23%). Percutaneous endoscopy was used to directly visualize the biliary-enteric anastomosis, diagnose pathology (e.g., ischemic cholangiopathy), and help in biliary hygiene (removing debris/casts/stones/stents) in 138/201 (69%) procedures. Technical success was defined as cannulating the biliary-enteric anastomosis and performing diagnostic/therapeutic procedure via the MHLA. RESULTS: The technical success rate was 95% (190/201). The failure rate among procedures performed with and without endoscopy was 2% (3/138) versus 13% (8/63) (P = 0.0024), and the need for new transhepatic access (to aid the procedure) was 12% (16/138) versus 30% (19/63) (P = 0.001). Despite endoscopy, failure in 2% of the cases resulted from inflamed/friable anastomosis (1/3) and high-grade stricture (2/3) obstructing retrograde cannulation of biliary-enteric anastomosis. Major adverse events (bowel perforation and injury) occurred in 1% of the procedures, with no procedure-related mortality. CONCLUSIONS: MHLA-based percutaneous biliary intervention is a safe and effective alternative to managing complications after liver transplant. Percutaneous endoscopy via the MHLA improves success rates and may reduce the need for new transhepatic access. Level of Evidence Level 4.

Social dysfunction relates to shifts within socioaffective brain systems among Schizophrenia and Alzheimer's disease patients.

Social dysfunction represents one of the most common signs of neuropsychiatric disorders, such as Schizophrenia (SZ) and Alzheimer's disease (AD). Perturbed socioaffective neural processing is crucially implicated in SZ/AD and generally linked to social dysfunction. Yet, transdiagnostic properties of social dysfunction and its neurobiological underpinnings remain unknown. As part of the European PRISM project, we examined whether social dysfunction maps onto shifts within socioaffective brain systems across SZ and AD patients. We probed coupling of social dysfunction with socioaffective neural processing, as indexed by an implicit facial emotional processing fMRI task, across SZ (N = 46), AD (N = 40) and two age-matched healthy control (HC) groups (N = 26 HC-younger and N = 27 HC-older). Behavioural (i.e., social withdrawal, interpersonal dysfunction, diminished prosocial or recreational activity) and subjective (i.e., feelings of loneliness) aspects of social dysfunction were assessed using the Social Functioning Scale and De Jong-Gierveld loneliness questionnaire, respectively. Across SZ/AD/HC participants, more severe behavioural social dysfunction related to hyperactivity within fronto-parieto-limbic brain systems in response to sad emotions (P = 0.0078), along with hypoactivity of these brain systems in response to happy emotions (P = 0.0418). Such relationships were not found for subjective experiences of social dysfunction. These effects were independent of diagnosis, and not confounded by clinical and sociodemographic factors. In conclusion, behavioural aspects of social dysfunction across SZ/AD/HC participants are associated with shifts within fronto-parieto-limbic brain systems. These findings pinpoint altered socioaffective neural processing as a putative marker for social dysfunction, and could aid personalized care initiatives grounded in social behaviour.

White Box Watermarking for Convolution Layers in Fine-Tuning Model Using the Constant Weight Code.

Deep neural network (DNN) watermarking is a potential approach for protecting the intellectual property rights of DNN models. Similar to classical watermarking techniques for multimedia content, the requirements for DNN watermarking include capacity, robustness, transparency, and other factors. Studies have focused on robustness against retraining and fine-tuning. However, less important neurons in the DNN model may be pruned. Moreover, although the encoding approach renders DNN watermarking robust against pruning attacks, the watermark is assumed to be embedded only into the fully connected layer in the fine-tuning model. In this study, we extended the method such that the model can be applied to any convolution layer of the DNN model and designed a watermark detector based on a statistical analysis of the extracted weight parameters to evaluate whether the model is watermarked. Using a nonfungible token mitigates the overwriting of the watermark and enables checking when the DNN model with the watermark was created.

Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy.

The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.

Do Platelet-Rich Plasma Injections for Knee Osteoarthritis Work?

BACKGROUND: Recent evidence suggests a benefit in platelet-rich plasma injections (PRP) for the knee in the management of mild to moderate osteoarthritis (OA). There is a reported reduction in pain, stiffness, and improved function. However, there is very little level-one literature available that supports this practice and conclusively proves a benefit gained throughout the course. Three main randomized control trials (RCTs) conducted in North America are often referenced and cited to prove their efficacy. This study aimed to look at the outcomes of patients having undergone this treatment to determine if there was any benefit. AIMS: This study aimed to determine if PRP injections administered in patients with knee OA over a six to eight-week time period demonstrated any benefit. METHODS: The Western Ontario and McMaster Universities arthritis index (WOMAC) tool was used before each of the three PRP injections over the six to eight-week period, and six weeks after the final injection in 31 patients. Each injection was given spaced two to three weeks apart. The outcomes observed were pain, stiffness, and physical function, and the total WOMAC score was calculated. RESULTS: The third injection showed a reduction in total WOMAC score, pain, stiffness, and physical function by 16.36%, 16.37%, 5.12%, and 18.03%, respectively. However, all scores returned close to baseline at the sixth-week follow-up post treatment. CONCLUSION: Results showed a trend of reduction in the WOMAC score. However, they are overall indicative of a placebo effect from the injections. Further studies are needed to explore whether the grade of OA and patients' weight have a significant impact on the results.

Percutaneous sequential closure of an Abernethy malformation: A case report.

Abernethy malformation (congenital extrahepatic portosystemic shunt [CEPS]) is rare and is characterized by an aberrant connection between the portal and systemic veins, bypassing the liver. It can have varying presentations and can lead to severe complications if left untreated. It is usually diagnosed incidentally on abdominal imaging. Occlusion venography and measurement of portal pressures (pre- and postocclusion) is an important step in management. Complete occlusion of the malformation in cases where the portal veins in the liver are very small and the gradient is more than 10 mm Hg, can potentially lead to acute portal hypertensive complications, such as porto-mesenteric thrombosis. We report a case of Abernethy malformation diagnosed on an abdominal computed tomography scan that presented with neurological symptoms and was successfully managed by interventional radiology via endovascular closure through placement and sequential occlusion of 2 metal stents.