# Clinical outcomes of endovascular therapy strategy based on thrombus location for acute superior mesenteric artery occlusion

## TL;DR

This study shows that tailoring endovascular therapy to the location of blood clots in the superior mesenteric artery improves outcomes for patients with acute occlusion.

## Contribution

The study introduces a strategy of selecting endovascular techniques based on thrombus location to improve clinical outcomes in acute superior mesenteric artery occlusion.

## Key findings

- Tailored endovascular therapy achieved a 100% technical success rate.
- Peripheral thrombus was strongly associated with bowel necrosis and higher mortality.
- All acute occlusion-related deaths were linked to extensive bowel necrosis.

## Abstract

To evaluate the short-term outcomes of patients with acute superior mesenteric artery occlusion who underwent endovascular therapy using different endovascular techniques based on thrombus location.

This single-center retrospective observational study included consecutive patients with acute superior mesenteric artery occlusion who underwent endovascular therapy using a single or combined approach, including aspiration embolectomy, local thrombolysis, antegrade stenting, and balloon angioplasty, with or without necrotic bowel resection, between January 2007 and December 2024. The thrombus location was classified as proximal, middle, and peripheral based on angiographic findings, and endovascular therapy strategies were selected based on thrombus location. The initial endovascular technique was selected as follows: aspiration embolectomy or antegrade stenting for proximal thrombus, aspiration embolectomy for middle thrombus, and local thrombolysis for peripheral thrombus. Outcomes assessed included technical success (reperfusion of blood flow in the primary occluded superior mesenteric artery segment targeted by endovascular therapy), procedure-related adverse events, bowel necrosis, bowel resection, all-cause 30-day mortality, and acute superior mesenteric artery occlusion-related 30-day mortality.

Thirty-three consecutive patients (mean age 76.0 ± 8.9 years; 20 male) were included. The technical success rate was 100%. Procedure-related adverse events occurred in 15.2% patients (four arterial injuries and one distal embolization). Bowel necrosis was observed in 36.4% patients (n = 12), with 33.3% (n = 11) requiring necrotic bowel resection. All bowel necrosis cases were associated with peripheral thrombus. All-cause 30-day mortality and acute superior mesenteric artery occlusion-related 30-day mortality rates were 15.8% (n = 5) and 9.3% (n = 3), respectively. Extensive thrombus involving the peripheral region was significantly associated with bowel necrosis (P < 0.05). All acute superior mesenteric artery occlusion-related deaths were linked to extensive bowel necrosis.

Tailored endovascular strategies based on thrombus location may contribute to favorable clinical outcomes in patients with acute superior mesenteric artery occlusion.

Endovascular therapy (EVT) based on thrombus location for acute superior mesenteric artery occlusion demonstrated favorable success rates/lower 30-day mortality. Peripheral thrombus was strongly associated with bowel necrosis; extensive necrosis correlated with higher mortality.