We present the case of a 72-year-old man with atrial fibrillation who developed an embolic occlusion of the superior mesenteric artery. He was successfully treated with local fibrinolysis using streptokinase associated with angioplasty. Such local treatments without the need of surgery are very rarely reported in the literature because of the great difficulty in selecting patients without intestinal necrosis, but represent an important option in the algorithm for the management of acute mesenteric ischemia. The patient was in good condition without recurrent embolism during the six months follow-up.