Objective: To investigate the effectiveness and safety of catheter-directed thrombolysis (CDT) in treatment of acute superior mesenteric artery thrombosis (ASMAT).   
Methods: The clinical data of 24 patients with ASMAT undergoing CDT from January 2012 to February 2017 were retrospectively analyzed.  
Results: Of the 24 patients, 14 cases were males and 10 cases were females, with an average age of (68.6±11.2) years; the average time from onset to consultation was (8.2±3.4) h. All patients underwent CDT or CDT plus other endovascular procedures, with an average time of (42.8±8.3) h for CDT. Eighteen patients (75.0%, 18/24) were cured, of whom, the onset time was less than 6 h in 10 cases and 6-12 h in 8 cases; 14 cases underwent CDT alone, 2 cases underwent CDT plus percutaneous transluminal angioplasty (PTA), and 2 cases underwent CDT plus PTA and stent implantation. Four patients (16.7%, 4/24) were improved, of whom, the onset time was 6-12 h in 3 cases and 20 h in 1 case; all underwent CDT plus PTA. Treatment failed in 2 patients (8.3%, 2/24), of whom, the onset time was 9 and 19 h respectively; 1 case showed peritoneal irritation signs 30 h after CDT, then underwent bowel resection and anastomosis with approximately 150.0 cm of small bowel resected, and after that, the abdominal symptoms disappeared and the postoperative recovery was satisfactory, while the other case showed peritoneal irritation signs 10 h after CDT, then underwent bowel resection and anastomosis, but the remnant small bowel was only about 200 cm in length and after that, short bowel syndrome occurred and the patient died of myocardial infarction on the 7th day after operation. Twenty-three patients were followed up for (43±17) months, no recurrence and aggravation occurred; CTA showed about 50% stenosis within the stent in 
1 case with stent implantation, for which no treatment was given because of no clinical symptoms.
Conclusion: CDT is a safe, effective and minimally invasive method in treatment of ASMAT.