Night has fallen, but the medical staff in the catheterization room of our hospital is still busy, and the atmosphere has lasted for nearly 4 hours since 2:00 pm. The patient lying on the operating table was an elderly female patient with a history of “rheumatic heart disease, mitral stenosis and atrial fibrillation” for more than 30 years, who was admitted to the hospital because of “sudden onset of pain, spasm, numbness and syncope in the left lower limb”. The left N artery and dorsalis pedis artery pulsation had disappeared, and the skin of the foot had become cold and pale, and the color was significantly darker than the opposite side. The patient was in pain, and if appropriate measures were not taken in time, the limb would soon become necrotic, and there was a risk of amputation. After consultation with relevant experts from the thrombosis department, it was decided to give interventional thrombolytic treatment. The patient was quickly pushed into the catheterization room. The right femoral artery was punctured and cannulated, and a mudskipper guidewire was sent through the Cobra catheter to the left external iliac artery, which was exchanged into a straight-ended lateral hole thrombolytic catheter, which was slowly pushed to the distal femoral artery under the guidance of the guidewire. There was a 4- to 6-cm-long contrast filling defect from the middle to the end of the N artery, with poor antegrade flow, and irregular stenosis of about 90% and 80% in the proximal segment of the anterior tibial and posterior tibial arteries, respectively. The diagnosis of acute N artery embolism, secondary arterial thrombosis, and stenosis of the proximal anterior tibial and posterior tibial arteries had been clearly established, so the thrombolytic catheter was placed into the thrombus site and urokinase was slowly pushed for about 30 minutes with 500,000 units of urokinase, and no significant improvement was seen in the antegrade flow on repeated imaging, suggesting that the thrombolytic effect was not apparent. Based on the imaging situation and the fact that the effect of thrombolysis alone was poor, the new treatment strategy of “balloon dilatation and placement of a catheter for thrombolysis” was implemented after further analysis of the treatment plan and re-communication with the patient and family. So, the balloon catheter was exchanged to the thrombus site, and after several times of pressure dilation, the thrombolytic catheter was left inside the thrombus, and the thrombolytic drug was continued to be infused to perform 48 hours of sequential thrombolysis. A miracle finally occurred. The next day, the pain of the left lower extremity was completely relieved, the color and temperature of the skin returned to normal, and the dorsalis pedis artery pulsation appeared and was significantly stronger than the opposite side. The patient’s pain was relieved and the risk of limb necrosis and amputation was avoided. This is also the first case of acute lower limb arterial embolism successfully treated by “interventional balloon dilation and placement of perfusion thrombolysis” in our hospital.