Abstract
A 79-year-old man with coumadine administration, who had mitral valve replacement and pacemaker implantation, was admitted for the treatment of gastric cancer. Sudden abdominal pain developed and contrast-enhanced computed tomography (CE-CT) showed superior mesenteric artery (SMA) occlusion. Although transcatheter administration of tissue plasminogen activator (t-PA) did not recanalize the occluded artery, we revascularized with a combination of thrombolysis and percutaneous transluminal angioplasty (PTA), which caused peripheral embolization with melena. The second attack occurred 14 days after the first attack and we performed a combination therapy of thrombolysis, thromboaspiration, and PTA to achieve sufficient recanalization with little peripheral embolism. Early recanalization with a transcatheter combination therapy may be an attractive treatment for the improvement of superior mesenteric ischemia with poor prognosis to minimize distal embolism.
