Acute mesenteric ischemia following ischemic stroke: a rare sequential embolic event managed with Ethiopia’s first endovascular intervention

Abstract

Introduction and importance: Acute mesenteric ischemia (AMI) is defined as a sudden interruption of blood flow to a segment of the intestine, leading to ischemia, inflammation, and potential bowel necrosis if untreated. It is a life-threatening vascular emergency, and its occurrence following an acute ischemic stroke is exceedingly uncommon, with very few reports in the literature. Case presentation: We report a 76-year-old woman with chronic atrial fibrillation and degenerative valvular heart disease who presented with acute ischemic stroke and, on the third day of admission, developed sudden, severe epigastric pain. Contrast-enhanced computed tomography angiography of the abdomen revealed complete occlusion of the distal superior mesenteric artery. Prompt endovascular thrombectomy achieved approximately 80% recanalization, resulting in complete symptom resolution without the need for surgical resection. The patient also recovered neurologically with no further complications. Clinical discussion: AMI is frequently associated with advanced age and cardioembolic risk factors and remains difficult to diagnose due to nonspecific symptoms. This challenge is amplified in post-stroke patients. Contrast-enhanced CT angiography is essential for timely diagnosis, as early imaging significantly improves detection and facilitates prompt revascularization. Conclusion: This case highlights the extreme rarity of AMI following stroke, underscores the need for heightened vigilance in patients with cardioembolic risk factors, and demonstrates the feasibility and success of early endovascular intervention, especially when thrombolysis is contraindicated. To our knowledge, this represents the first documented case of endovascular thrombectomy for mesenteric ischemia in Ethiopia, emphasizing the expanding role of minimally invasive vascular therapy in resource-limited settings.