Hye Jin Yang, et al. tire distal trunk of the SMA, the iliocolic, and jejunal branch- cluded (Fig. 2B). es (arrowheads), leaving the SMA main trunk nearly oc- After cannulation of the SMA main trunk with a 2.4F mi- Fig. 1. Abdominal CT shows a focal dissecting flap in the proximal SMA (white arrow) with severely narrowed true lumen. CT, computed tomogra- phy; SMA, superior mesenteric artery. crocatheter, a total of 500,000 I.U urokinase were continuous- ly infused through angiographic catheter and microcatheter separately during 15 minutes, and aspiration embolectomy was performed with a 7F aspiration catheter. After removal of most of the thrombus within the SMA main trunk, a 7 mm ×6 cm self expandable stent (Protégé; Micro Therapeutics, ev3, Irvine, CA, USA) was deployed over the dissection flap at the proximal SMA (white arrows), while jejunal branches remained occluded due to distally migrated throm- bus (white arrowheads) (Fig. 3A). Completion angiography showed a completely excluded dissecting flap in the proxi- mal SMA and complete recanalization of the SMA and its branches (Fig. 3B). The patient experienced complete im- A B Fig. 2. (A) The first frame of the initial SMA angiography shows a focal dissecting flap 2 cm distally from the origin (arrow), aneurismal change of the proximal SMA (arrow heads), and narrowing of the distal trunk of the SMA. (B) The second frame of the same angiography shows sudden extension of the dissecting flap to the distal trunk of the SMA (arrows) and propagated intraluminal thrombus (arrow- heads) immediately after simple passage of contrast material via a 6F guiding catheter. SMA, superior mesenteric artery. A B Fig. 3. (A) Follow-up angiography after deployment of a 7 mm×6 cm self expandable stent shows a completely excluded dissection flap with recanalized SMA trunk (white arrows), but multiple jejunal branches are occluded due to distally migrated thrombus (white arrow- heads). (B) Completion angiography shows complete recanalization and removal of intraluminal thrombus after additional pharmacome- chanical thrombolysis. SMA, superior mesenteric artery. 860 Yonsei Med J http://www.eymj.org Volume 52 Number 5 September 2011