Case Report: Beyond the ulcer: 51-month durability of left gastric artery embolization for obesity management in an antiplatelet-dependent, surgery-ineligible patient.

We report a 51-month follow-up of transcatheter left gastric artery embolization (LGAE) in a 54-year-old male with central obesity (BMI 29.1 kg/m2, waist circumference 107 cm), post-stroke disability, osteoarthritis-induced immobility, compulsive binge eating, alcohol dependence, and clopidogrel-treated antiplatelet therapy-rendering conventional weight-loss interventions ineffective or contraindicated. Despite developing an 8-cm iatrogenic gastric ulcer at 30 days post-procedure, complete endoscopic healing was achieved with proton pump inhibitors and mucosal protectants. Sustained weight loss of 15.2% (from 84 kg to 71.2 kg) with 14.6 cm waist reduction correlated with resolution of knee pain (WOMAC score 68 → 12), sleep apnea, fatty liver (ALT 119 → 28 U/L), and dyslipidemia. This case demonstrates LGAE's long-term efficacy in high-risk, surgery-ineligible obesity while highlighting the necessity of rigorous management for significant embolization-related complications, suggesting vascular remodeling capacity in gastric mucosa.