Endovascular Thrombectomy for Acute Mesenteric Ischemia Using the Solitaire Device
Kogulan Nadesakumaran, MD, Jeffrey C. Hnath, MD, Nikolaos Zacharias, MD, R. Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
OBJECTIVE: We report a case of a female presenting with acute mesenteric ischemia treated with experimental endovascular approach using the Solitaire Device (Covidien-Medtronic ™, Minneapolis, MN).
METHODS: The Solitaire Device has been successfully used in cerebral artery thrombectomy cases by neurosurgeons. We elected to use the device in a 62-year old female with acute mesenteric ischemia.The patient had multiple comorbidities including colon cancer, endometrial cancer status post radiation complicated by radiation enteritis, and previous small bowel obstruction therefore deemed inoperable. The patient's family decided against any open surgical intervention. Wire access was obtained down into the superior mesenteric artery (SMA) and 10mg of TPA was given intra-arterially. Wires were then places across the thrombus and a Solitaire clot extraction device™ was placed down the SMA and passed multiple times to remove the thrombus. A 4mm balloon was used to angioplasty the distal branch of the SMA.
RESULTS: Follow-up imaging demonstrated improved flow with only a small amount of residual thrombus. Her abdominal pain symptoms subsided and were able to tolerate a diet with normal bowel function. She was discharged on aspirin. (see completion angiogram below)
CONCLUSIONS: The Solitaire device may be a new addition in the endovascular toolbox for the treatment of acute mesenteric ischemia.
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