2020 Volume 2 Issue 9 Pages 540-541
A 42-year-old man visited the emergency room 3 h after the onset of severe abdominal pain. CT revealed an occlusion in the proximal superior mesenteric artery (SMA) (Figure A,B), but no indication of mesenteric ischemia despite elevated lactate (8.0 mmol/L). We attached the SMA with a 4.5Fr guide-catheter through his left arm (Figure C), and then guided a 0.014-wire to the distal part. Intravascular ultrasound (IVUS) identified a possible tiny collapsed true lumen (TL) (Figure D, Supplementary Movie 1), which gave us a clue to the diagnosis – spontaneous SMA dissection. We reduced the presumed false lumen with an aspiration catheter for pressure reduction. Subsequent IVUS clearly demonstrated a large dissection and collapsed TL (Figure E, Supplementary Movie 2). We were convinced the SMA occlusion was attributed to the spontaneous SMA dissection. We guided another 0.014-wire to the TL (Figure F), and placed a self-expanding stent (7×60 mm) in the proximal SMA. Repeat IVUS showed adequate stent expansion (Figure G). Since then, the patient has had an uneventful course without recurrence of dissection and aneurysmal formation (Figure H).
(A,B) CT shows the proximal occlusion of the SMA (arrow). (C) Angiography demonstrates total occlusion in the proximal SMA (arrow). (D–G) IVUS reveals possible tiny collapsed true lumen (arrow), a clear dissection image after aspiration (arrow), another wire in the true lumen (arrow), and adequate expanded stent. (H) 3-year follow-up CT shows the stent is patent without residual dissection. CT, computed tomography; IVUS, intravascular ultrasound; SMA, superior mesenteric artery.
Spontaneous SMA dissection is rare but potentially catastrophic. Recent reports have highlighted excellent stent patency in the short and long-term.1 Both pre-CT and initial angiography do not always give a clear image of SMA dissection, whereas IVUS will provide a definite diagnosis and treatment guidance for this disorder.
The authors declare no conflicts of interest.
The present study was approved by the Institutional Review Board Committee of Ota Memorial Hospital (reference no. OR20015).
Supplementary Movie 1. Initial IVUS image.
Supplementary Movie 2. IVUS image after aspiration.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circrep.CR-20-0061
