Role of Imaging Classification in Guiding Treatment Strategies for Spontaneous Isolated Superior Mesenteric Artery Dissection: A Comparative Study of Conservative and Endovascular Approaches

For SISMAD, initial conservative treatment proves both safe and effective, particularly for symptomatic type IV patients. When required, endovascular interventions are tailored according to detailed imaging results. Both BMS and BMSAC initially alleviate symptoms effectively, but BMSAC is superior in achieving completely vascular remodeling, particularly notable in type I and chronic dissections.Clinical ImpactThis study provides important insights into the treatment of Spontaneous Isolated Superior Mesenteric Artery Dissection (SISMAD), highlighting the efficacy of both conservative and endovascular approaches. We find that initial conservative treatment is safe and effective, particularly for symptomatic Type IV patients, aligning with European guidelines that recommend conservative management as a first-line treatment. However, for cases requiring intervention, endovascular treatments, specifically bare metal stent-assisted coiling (BMSAC), show superior outcomes in achieving complete vascular remodeling compared to bare metal stent (BMS). This study supports the tailored use of endovascular procedures based on detailed imaging, thus enhancing treatment protocols and potentially improving patient outcomes in clinical practice.