Background and Aims In recent years, the Acostream and Angiojet mechanical thrombectomy devices have been widely used to treat various thromboembolic diseases. However, few reports have been on their use in treating acute superior mesenteric artery embolism (ASMAE), and no comparative studies on their efficacy in ASMAE treatment have been published. Therefore, this study was performed to summarize and compare the cases of ASMAE treated with Acostream or Angiojet in the authors' institution to provide a reference for clinical treatment selection.Methods The clinical data of 23 ASMAE patients treated with mechanical thrombectomy devices in Department of Vascular Surgery, Quzhou People's Hospital between January 2019 and January 2023 were retrospectively analyzed. Of the patients, 10 cases were treated with the Acostream thrombus suction device (Acostream group), and 13 cases received treatment with the Angiojet mechanical thrombus fragmentation device (Angiojet group). The basic patient data (sex, age, onset time, signs of peritonitis, embolism location, concomitant embolism in other areas, and past medical history), intraoperative observation indicators (intraoperative blood loss, usage of balloon and stent), complications (incidence of target vessel dissection, incidence of distal arterial embolism, and incidence of bleeding events), and postoperative intestinal necrosis and perioperative mortality were compared between the two groups. The pre-and postoperative NRS pain scores, white blood cell (WBC) counts, D-dimer levels, hemoglobin levels, and the rate of abdominal pain relief, thrombus recurrence rate, and lumen restenosis during follow-up were also analyzed.Results The two groups had no statistically significant differences in the basic data (all P>0.05). The incidence of intraoperative target vessel dissection was lower in the Acostream group compared to the Angiojet group (10.0% vs. 53.8%, P<0.05). The two groups had no significant differences regarding intraoperative blood loss, distal arterial embolism, stent, and balloon usage rate, the incidence of bleeding events, and perioperative mortality (all P>0.05). Among the 5 patients with signs of peritonitis, two cases (one from each group) did not experience pain relief after endovascular surgery and underwent bowel resection after laparoscopy confirmed intestinal necrosis. There were no significant changes in hemoglobin levels before and after surgery in either group (both P>0.05). However, postoperative NRS pain scores, WBC counts, and D-dimer levels decreased compared to preoperative levels (some P<0.05), with similar trends observed between the two groups. During postoperative follow-up, all patients experienced complete relief of abdominal pain symptoms. One patient in the Acostream group was readmitted due to acute cerebral infarction. Upon re-examination with abdominal aorta CTA or enhanced whole abdominal CT, no patients had recurrent thrombosis or severe stenosis in the superior mesenteric artery trunk, and no patients died.Conclusions Both Acostream and Angiojet thrombectomy devices are safe and effective for treating ASMAE. However, attention should be given to the formation of target vessel dissection when using the Angiojet mechanical thrombectomy device. Clinical decisions should be based on the patient's overall condition when selecting an individualized surgical plan.