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

Abstract

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.