We read with great interest the recent article by Raupach et al. [1]. The authors raised an important issue on the endovascular management of acute embolic occlusion of the superior mesenteric artery (SMA). The authors reported that two patients with the flow limiting stenosis of the main stem of the SMA after aspiration received stent placement; also, they made an algorithm for the treatment of acute embolic SMA occlusion (Table 3). We would like to elaborate on the stent placement in the stem of the SMA and the algorithm.
Acosta et al. [2] reported a group of patients who received endovascular management of acute SMA occlusion, and the results of adjunctive local thrombolysis (rtPA at a rate of 0.5–1 mg/h) for incomplete aspiration embolectomy with residual clot were great. Also, the results of adjunctive local thrombolysis were proved in our report [3]. According to the authors report, two patients with the flow limiting stenosis of the main stem of the SMA after aspiration received stent placement [2]. Although stenting achieves good results initially, restenosis of the side branches or even obstruction in the stented segment is inevitable in the long-term follow-up [4]. We believe the two cases should receive adjunctive local thrombolysis after aspiration, and then stenting if aspiration and local thrombolysis fail.
In the algorithm, the (aspiration + stenting + thrombolysis) is confusing; the authors should declare aspiration as an initial treatment , and adjunctive local thrombolysis should be performed if aspiration fails, and stenting is a treatment choice if both aspiration and adjunctive local thrombolysis fail.
References
Raupach J, Lojik M, Chovanec V, et al. Endovascular management of acute embolic occlusion of the superior mesenteric artery: a 12-year single-centre experience. Cardiovasc Intervent Radiol. 2016;39:195–203.
Acosta S, Sonesson B, Resch T. Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Intervent Radiol. 2009;32:896–905.
Jia Z, Jiang G, Tian F, et al. Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. Eur J Vasc Endovasc Surg. 2014;47:196–203.
Chang CF, Lai HC, Yao HY, et al. True lumen stenting for a spontaneously dissected superior mesenteric artery may compromise major intestinal branches and aggravate bowel ischemia. Vasc Endovascular Surg. 2014;48:83–5.
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Jia, Z., Wang, K. & Jiang, G. Regarding “Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience”. Cardiovasc Intervent Radiol 39, 1081 (2016). https://doi.org/10.1007/s00270-016-1341-2
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DOI: https://doi.org/10.1007/s00270-016-1341-2