Transjugular intrahepatic portosystemic shunt (TIPS) have been shown to be an efficient portal systemic derivative treatment for Budd Chiari syndrome (BCS) patients uncontrolled by medical therapy. However, the main drawback of TIPS for this condition is a very high rate of shunt dysfunction. Recently, polytetrafluoroethylene (PTFE) covered stents have been shown to reduce the incidence of TIPS dysfunction in patients with cirrhosis. The aim of the study was to assess the incidence of TIPS dysfunction in 2 cohorts of BCS patients treated with bare or PTFE covered stents. The study included 25 TIPS procedures (16 bare stents and 9 covered stents) with a median follow up period of 20.4 months (range, 3.9-124.8). Fourteen of 16 patients (87%) receiving bare stents had TIPS dysfunction compared to 3 of the 9 patients (33%) receiving PTFE covered stents (P = .005). The actuarial rates of primary patency in the bare stent group were 19%at 1 year compared with 67%in the PTFE covered stent group (P= .02; log rank test). The number of additional interventional procedures to maintain TIPS patency was significantly greater in the bare stent than in the PTFE covered stent group (1.9 ±1.2 vs. 0.6 ±0.9; P=.007). The number of patients with clinical relapses was greater in the bare stent group compared to the PTFE covered stent group (13 vs. 5 episodes in 9 and 3 patients, respectively). In conclusion, PTFE covered stents have a considerable advantage over bare stents for the TIPS treatment of BCS patients, with a lower dysfunction rate, a lower number of reinterventions, and fewer prosthesis requirements. PTFE covered stents are preferable in patients with Budd Chiari Syndrome. However, the main drawback of TIPS for this condition is a very high rate of shunt dysfunction. Recently, polytetrafluoroethylene (PTFE) covered stents have been shown to reduce the incidence of TIPS dysfunction in patients with cirrhosis. The aim of the study was to assess the incidence of TIPS dysfunction in 2 cohorts of BCS patients treated with bare or PTFE covered stents. The study included 25 TIPS procedures (16 bare stents and 9 covered stents) with a median follow up period of 20.4 months (range, 3.9-124.8). Fourteen of 16 patients (87%) receiving bare stents had TIPS dysfunction compared to 3 of the actuarial rates of primary patency in the bare stent group were 19% at 1 year compared with 67% in the PTFE-covered stent gro (P = .005) The number of additional interventional procedures to maintain TIPS patency was significantly greater in the bare stent than in the PTFE covered stent group (1.9 ± 1.2 vs. 0.6 ± 0.9; P = .007 The number of patients with clinical relapses was greater in the bare stent group than to the PTFE covered stent group (13 vs. 5 episodes in 9 and 3 patients, respectively). In conclusion, PTFE covered stents have a considerable advantage over bare stents for the TIPS treatment of BCS patients, with a lower dysfunction rate, a lower number of reinterventions, and fewer prosthesis requirements. PTFE covered stents are preferable in patients with Budd Chiari Syndrome.