Spontaneous Isolated Superior Mesenteric Arterial Dissection Treated with a Coronary Covered Stent: A Case Report

Abstract

Spontaneous isolated dissection of the superior mesenteric artery is rare with a wide spectrum of clinical symptoms. The management of isolated dissections mainly depends on the clinical symptomatology and imaging presentation. This case report describes a 51-year-old male presenting with persistent abdominal pain. Computed tomography angiography revealed an isolated superior mesenteric arterial dissection associated with severe true lumen stenosis and thrombosed false lumen with an ulcer-like projection. Definitive treatment was performed with a coronary covered stent to reopen the true lumen and completely exclude the false lumen.

Keywords: Computed tomography angiography; Covered stent; Dissection; Outcome; Superior mesenteric artery.

Fig. 1

Preinterventional sagittal reconstruction arterial-phase CTA revealed focal postostial stenosis of the superior mesenteric artery main branch (arrow), distal to the ulcer-like false lumen opacification (arrowheads). CTA, computed tomography angiography.

Fig. 2

(A) A selective angiography was performed prior to stenting. Selective angiography of the superior mesenteric artery confirmed the postostial stenosis of the main branch (arrow), distal to the ulcer-like false lumen opacification (arrowheads). (B) A selective angiography was performed after stenting. Selective angiography after covered stent placement (arrowheads) revealed fully patent superior mesenteric main branch and mild vascular spasm at the distal end of the covered stent (arrow).

Fig. 3

A follow-up CTA was performed. Reconstructed sagittal three-dimensional images of the CTA, 13 months after stenting procedure demonstrated the fully patent stent (arrowheads) without any opacification of a residual false lumen. CTA, computed tomography angiography.