Mechanical Recanalization for Acute Embolic Occlusion at the Origin of the Superior Mesenteric Artery

2017 ◽  
Vol 51 (2) ◽  
pp. 91-94 ◽  
Author(s):  
Yoichi Miura ◽  
Tomohiro Araki ◽  
Mio Terashima ◽  
Junya Tsuboi ◽  
Yasuhiro Saito ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mechanical Thrombectomy ◽  
Chronic Atrial Fibrillation ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Large Artery ◽  
Intestinal Necrosis ◽  
Computed Tomographic ◽  
Solitaire Fr

Purpose: We report a combined technique consisting of thrombectomy and thromboaspiration for the treatment of acute embolic occlusion of the superior mesenteric artery (SMA) at the origin. Case: A 90-year-old female with chronic atrial fibrillation had a sudden onset of abdominal pain and hematochezia due to acute embolic occlusion at the origin of the SMA. Computed tomographic findings showed reversible bowel wall ischemia. We performed mechanical thrombectomy using the Solitaire FR revascularization device, a self-expanding and fully retrievable stent-based thrombectomy system for acute intracranial large artery occlusion, combined with manual aspiration through a 6F guiding sheath placed at the SMA origin via a right brachial approach. Prompt and complete recanalization of the SMA was obtained without distal embolism, and intestinal necrosis was avoided. Conclusion: Combined endovascular procedures of mechanical thrombectomy using the Solitaire FR with thromboaspiration may allow prompt recanalization, clot removal, and prevention of distal embolism and therefore would be a new therapy for acute embolic occlusion at the origin of the SMA.

scholarly journals A novel method of mechanical thrombectomy utilizing a stent retriever device with continuous aspiration prior to intracranial vascular embolectomy technique for acute superior mesenteric artery occlusion: A case report

2021 ◽  
Vol 5 ◽  
pp. 24
Author(s):  
Hitoshi Ando ◽  
Richard H. Kaszynski ◽  
Hideaki Goto
Keyword(s):  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mechanical Thrombectomy ◽  
Thrombus Formation ◽  
Sudden Onset ◽  
Stent Retriever ◽  
Oral Feeding ◽  
Watery Diarrhea ◽  
Intestinal Necrosis

Acute superior mesenteric artery (SMA) occlusion resulting from a thrombus formation carries a high mortality risk and therefore immediate diagnosis and treatment are warranted. In recent years, mechanical thrombectomy by interventional radiology has become a viable treatment option if the occlusion has not advanced to intestinal necrosis. We present a rare and interesting case involving a patient with acute SMA occlusion which was completely recanalized by mechanical thrombectomy utilizing a stent retriever device and the continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE) technique. The CAPTIVE technique has become widely adopted in recent years to treat large vessel occlusions in the cerebrovascular region due to thrombi. First, a microcatheter with a microguidewire is advanced through the occlusive thrombus coaxially with an aspiration catheter. Next, a stent retriever is deployed in the thrombotic body and the aspiration catheter is advanced adjacently to the proximal part of the thrombus with strong aspiration until no backflow is present. After checking for backflow from the aspiration catheter, the microcatheter delivering the stent is removed to increase the aspiration force. Finally, the stent retriever and the aspiration catheter are retrieved as a single unit. An 87-year-old female patient with a history of atrial fibrillation (AF), chronic heart failure, aortic valve stenosis, hypertension, type2 diabetes mellitus, and hyperlipidemia was admitted to our hospital complaining of sudden onset upper abdominal pain, vomiting, and watery diarrhea. On arrival, her body temperature was 36.0°C (96.8°F), blood pressure was 131/75 mmHg, heart rate was 115 beats/min with AF rhythm, and her white blood cell count was 18,100 cells/μL. A contrast-enhanced computed tomography revealed a contrast defect in the SMA which we later diagnosed as an acute occluding thrombus of the SMA. Initially, we attempted aspiration of the thrombus but were unsuccessful, so we transitioned to mechanical thrombectomy utilizing a stent retriever device with CAPTIVE technique which rapidly and completely recanalized the occluded SMA. After the procedure, the patient’s abdominal pain immediately subsided. Normal stool was observed 2 days after the procedure and oral feeding was subsequently initiated. Twelve days after the procedure, the patient was discharged from the hospital in good health.

scholarly journals Mechanical Thrombectomy of Primary Distal Anterior Cerebral Artery Occlusion: A Case Report

2019 ◽  
Vol 11 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Hironori Haruyama ◽  
Junji Uno ◽  
Kenta Takahara ◽  
Yosuke Kawano ◽  
Naoki Maehara ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Anterior Cerebral Artery ◽  
Rare Condition ◽  
Computed Tomographic Angiography ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Computed Tomographic

Objective: Primary anterior cerebral artery (ACA) occlusion is a rare condition and sometimes leads to significant neurological deficits. We herein report on the efficacy of mechanical thrombectomy (MT) in treating the distal ACA occlusion in a clinical setting. Case Presentation: A 76-year-old woman presented with a sudden onset of right hemiparesis. Computed tomographic angiography and perfusion imaging and subsequent analysis with RAPID software revealed acute left ACA occlusion with salvageable penumbra. The patient obtained a score of 11 on the National Institutes of Health Stroke Scale. MT was performed for occlusion of the left ACA (A4), and successful reperfusion (Thrombolysis in Cerebral Infarction score of 3) was achieved on the first attempt using a stent retriever. The patient’s recovery progressed well, and she was discharged 13 days after admission with a modified Rankin Scale score of 1. Conclusion: This case report demonstrates the clinical efficacy, safety, and favorable clinical outcome of treating a primary distal ACA occlusion with MT.

Bridging Intravenous Thrombolysis Before Mechanical Thrombectomy for Large Artery Occlusion May be Detrimental with Thrombus Fragmentation

2020 ◽  
Vol 17 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Ho Jun Yi ◽  
Jae Hoon Sung ◽  
Dong Hoon Lee
Keyword(s):  
Clinical Outcome ◽  
Subgroup Analysis ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Stent Retriever ◽  
Large Artery ◽  
Simultaneous Application

Objective: We investigated whether intravenous thrombolysis (IVT) affected the outcomes and complications of mechanical thrombectomy (MT), specifically focusing on thrombus fragmentation. Methods: The patients who underwent MT for large artery occlusion (LAO) were classified into two groups: MT with prior IVT (MT+IVT) group and MT without prior IVT (MT-IVT) group. The clinical outcome, successful recanalization with other radiological outcomes, and complications were compared, between two groups. Subgroup analysis was also performed for patients with simultaneous application of stent retriever and aspiration. Results: There were no significant differences in clinical outcome and successful recanalization rate, between both groups. However, the ratio of pre- to peri-procedural thrombus fragmentation was significantly higher in the MT+IVT group (14.6% and 16.2%, respectively; P=0.004) compared to the MT-IVT group (5.1% and 6.8%, respectively; P=0.008). The MT+IVT group required more second stent retriever (16.2%), more stent passages (median value = 2), and more occurrence of distal emboli (3.9%) than the MT-IVT group (7.9%, median value = 1, and 8.1%, respectively) (P=0.004, 0.008 and 0.018, respectively). In subgroup analysis, the results were similar to those of the entire patients. Conclusion: Thrombus fragmentation of IVT with t-PA before MT resulted in an increased need for additional rescue therapies, and it could induce more distal emboli. The use of IVT prior to MT does not affect the clinical outcome and successful recanalization, compared with MT without prior IVT. Therefore, we need to reconsider the need for IVT before MT.

Diagnostic Pitfalls at Admission in Patients with Acute Superior Mesenteric Artery Occlusion

2012 ◽  
Vol 42 (6) ◽  
pp. 635-641 ◽  
Author(s):  
Stefan Acosta ◽  
Tomas Block ◽  
Steinarr Björnsson ◽  
Timothy Resch ◽  
Martin Björck ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Occlusion ◽  
Superior Mesenteric Artery Occlusion ◽  
Diagnostic Pitfalls ◽  
Mesenteric Artery Occlusion

Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion following Failed Surgical Embolectomy

2003 ◽  
Vol 10 (2) ◽  
pp. 386-391 ◽  
Author(s):  
Saim Yilmaz ◽  
Alihan Gürkan ◽  
Okan Erdoğan ◽  
Timur Sindel ◽  
Kağan Çeken ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Occlusion ◽  
Distal Embolization ◽  
Primary Stenting ◽  
History Of ◽  
Surgical Embolectomy ◽  
Failed Surgery ◽  
Symptom Recurrence

Purpose: To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy. Case Report: A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure. Conclusions: Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.

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