Background and Aims Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a relatively common type of visceral artery dissection, typically presenting with acute abdominal pain. In severe cases, it may lead to intestinal ischemia or even necrosis. With the widespread use of imaging techniques such as CT angiography (CTA), the detection rate of SISMAD has significantly increased. However, there is still controversy regarding its optimal treatment strategy, especially in choosing between conservative management and endovascular intervention, as no unified standard currently exists. This study aimed to compare the short- and medium-term outcomes of the two treatment modalities by retrospectively analyzing the clinical data of SISMAD patients treated at our center in order to provide evidence for individualized treatment decisions.Methods A retrospective analysis was conducted on 174 patients diagnosed with SISMAD at Ningbo Second Hospital between January 2018 and December 2023. Among them, 30 patients received conservative treatment, and 144 underwent endovascular intervention (including stent implantation alone or in combination with coil embolization of the false lumen). All patients were diagnosed using CTA or superior mesenteric artery angiography and classified accordingly. Patients were followed up at 1 month and 1 year after treatment to assess clinical symptom relief and radiological outcomes, including dissection remodeling and stent patency.Results In the conservative group, the symptom relief rate was 90.0% at 1 month and 92.8% at 1 year; in the interventional group, the corresponding rates were 99.3% and 98.6%. The difference in symptom relief at 1 month was statistically significant (P=0.016), while the difference at 1 year was not (P>0.05). Subgroup analysis by classification showed that the interventional group generally had higher symptom relief rates than the conservative group across all types. However, none of the differences reached statistical significance (all P>0.05). The conservative group showed poorer symptom control in type Ⅲ patients, including one death. The technical success rate of endovascular treatment was 99.3%, with no cases of stent displacement or occlusion within 1 year. The complete remodeling rate was 86.8%, and the stent patency rate was 100.0%. Some patients had minor mural thrombus formation within the stent without evidence of flow obstruction.Conclusion Endovascular intervention offers a high technical success rate and favorable short- and medium-term efficacy in SISMAD patients, particularly for type Ⅱ and Ⅲ cases with compromised true lumen perfusion. Treatment strategies should be tailored based on the dissection type and the degree of true lumen compression to improve clinical outcomes and reduce associated risks.