Mechanical Thrombectomy Using a Balloon Guide Catheter for Acute Occlusion of the Superior Mesenteric Artery

To evaluate the effectiveness and safety of mechanical thrombectomy using a balloon guide catheter (BGC) for acute occlusion of the superior mesenteric artery (SMA).

A retrospective review of 18 patients admitted to the authors' institute with acute SMA occlusion between April 2019 and March 2024 was conducted. Mechanical thrombectomy was performed with balloon occlusion. An 8-F BGC was advanced into the origin of the SMA, and after occlusion, a 6-F guiding catheter was advanced coaxially to aspirate the thrombus. Technical success was defined as the successful advancement of the BGC into the SMA. Therapeutic success was defined as complete thrombus removal and revascularization of the SMA.

Eighteen consecutive patients (median age, 78 years; range, 70-85 years; 11 men and 7 women) underwent mechanical thrombectomy using a BGC. Technical success was achieved in all (100%) patients. Therapeutic success was achieved in 17 (94%) patients. Six (33%) patients underwent bowel resection after endovascular therapy, and 1 (6%) patient developed short bowel syndrome. The 30-day mortality rate was 17%. There were 2 adverse events related to guide wire manipulation. In 1 patient, a guide wire perforation caused a retroperitoneal hematoma, and in a second patient, a guide wire caused an iatrogenic non-flow-limiting SMA dissection. Therapeutic intervention was not required in either case.

Mechanical thrombectomy using a BGC in acute SMA occlusion appears technically feasible; however, segmental bowel resection is still required in a minority of patients.