Purpose <p>Assess incidence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients treated with 8-10&#xa0;mm Controlled Expansion diameter VIATORR® (VCX) versus 10&#xa0;mm diameter first-generation VIATORR® (Legacy) stent-grafts.</p> Materials and methods <p>Single-centre retrospective study (January 2015 to March 2024), including 132 adult patients with cirrhosis treated with TIPS due to complications of portal hypertension. Outcomes included post-TIPS new onset overt HE, ascites response, re-bleeding, mortality and portal pressure gradient (PPG) before and after TIPS. Comparisons used Chi square and Fisher´s exact test for categorical variables and Student´s t test or Mann–Whitney test for quantitative variables.</p> Results <p>Indication for TIPS was refractory ascites (<i>n</i> = 82) and variceal bleeding (<i>n</i> = 50). The VCX group (<i>n</i> = 85) and the Legacy group (<i>n</i> = 47) had similar new onset overt HE: 37% (31/85) vs 43% (20/47), respectively (<i>p</i> = 0.31); mortality rates (34% [29/85]) vs 39% [18/47], respectively, <i>p</i> = 0.57) and re-bleeding (17% [6/35] vs 20% [3/15], respectively, <i>p</i> = 1.00). Median PPG reduction after TIPS was 10&#xa0;mmHg (7 – 13) in the VCX group and 12&#xa0;mmHg (9 – 15) in the Legacy group (<i>p</i> = 0.02). Subgroup analysis revealed post TIPS overt HE rate of 38% (19/50) in the VCX group vs 53% (17/32) in the Legacy group (<i>p</i> = 0.13), with refractory ascites as an indication. Shunt dysfunction rate was 7% (6/85) in the VCX group (stent thrombosis <i>n</i> = 6, stenosis or malpositioning <i>n</i> = 0) and 0% (0/47) in the Legacy group (<i>p</i> = 0.09).</p> Conclusion <p>VCX stent grafts induce an immediate lower PPG reduction, which might lead to more stent dysfunctions, but also to a reduction in post-TIPS HE.</p>