VIATORR stent has become the standard of care in transjugular intrahepatic portosystemic shunt (TIPS) placement due to its longer primary and secondary patency rates. However, TIPS shunt maintenance with percutaneous transluminal angioplasty (PTA) with or without stent extension may be needed in many patients. In our practice we routinely overdilate 10-mm VIATORR stents using a 12-mm high-pressure angioplasty balloon if the portosystemic pressure gradients are still inadequate after 10-mm PTA. We intend to retrospectively evaluate the efficacy and safety of this approach. IRB approval was obtained. We enrolled TIPS shunt revision cases with initial TIPS placement indication of either ascites or secondary variceal bleeding prophylaxis from 2010 to -2019. After applying exclusion criteria, 78 cases were recruited to this study, with 40 cases in the 10-mm PTA group as the control and 38 in the 12-mm PTA group. The post-procedural effect on hepatic encephalopathy, 30-day MELD scores and pertinent lab values including serum creatinine (sCr), total bilirubin (TBili), platelet count (PLT) and International Normalized Ratio (INR) plus the secondary patency duration were analyzed. Major and minor complications were evaluated to establish a safety profile. Baseline demographic characteristics of both patient groups were similar (P > 0.05). Multivariate logistic regression was conducted, which did not show any significantly different effect on hepatic encephalopathy, 30-day MELD score and lab values including sCr, TBili, PLT, or INR, or secondary patency duration between the 2 groups. Among all enrolled cases, there were no minor or major complication at 30-day follow-up. VIATORR stent overdilation with 12 -mm PTA may be a safe and effective technique to achieve the target intraprocedural portosystemic gradient when 10 -mm PTA is not adequate. This approach may avoid the need for a parallel TIPS placement procedure.