Taiwan Doctors Restore Brain Blood Flow in Rare Stroke Linked to Sjögren's Syndrome

A blocked brain artery, but no obvious clot to remove

A 46-year-old woman in Taichung regained normal movement and speech after doctors at Kuang Tien General Hospital reopened a major brain artery using a temporary scaffold and medication delivered directly into the vessel. Her first treatment attempt, 90 seconds of suction intended to remove a clot, had retrieved no appreciable clot and left the artery blocked.

The medical team attributed the stroke to blood vessel inflammation associated with primary Sjögren's syndrome, an autoimmune disease often associated with dry eyes and a dry mouth. Imaging showed complete blockage of the right distal M1 segment, a major section of the middle cerebral artery.

The hospital's published case report, released in the Journal of Inflammation Research on July 30, 2026, describes how doctors changed their approach when suction failed. They used Stent-Assisted Intracranial Lysis, known as SAIL, to restore blood flow without leaving a permanent stent inside the artery.

The woman, identified by the hospital as Ms. Wu, had no detectable neurological deficits at discharge. At 90 days, assessments recorded no remaining stroke symptoms or disability, although imaging still showed mild narrowing in the treated arterial region.

Why walking into hospital did not mean the danger was small

Ms. Wu developed sudden weakness in her left arm and leg, facial weakness and unclear speech. She could still walk when she reached Kuang Tien, and she could lift her affected limbs against gravity, although they weakened when an examiner applied resistance.

Her arrival score on the National Institutes of Health Stroke Scale, or NIHSS, was 6. The scale measures problems such as weakness, speech difficulty and reduced awareness; a score of zero means no deficits are detected by that examination.

The middle cerebral artery supplies several important functional areas of the brain. A complete blockage can therefore threaten a much larger area than the patient's initial symptoms might suggest.

Pao-Sheng Yen, a neuroradiologist and deputy superintendent at Kuang Tien, explained that alternative routes called collateral circulation can sometimes temporarily supply blood around a blockage. If that backup supply becomes inadequate, a person who is still walking can deteriorate rapidly. Doctors therefore acted on the brain scans as well as her outward condition.

The first seven hours shaped treatment

Ms. Wu had experienced symptoms for about six hours by the time of presentation described in the paper. She had been transferred from a hospital unable to perform thrombectomy, the procedure used to remove material blocking a brain artery.

Doctors withheld intravenous tissue plasminogen activator, a medicine used to dissolve clots, because she had arrived beyond the 4.5-hour treatment window they applied in this case. They instead pursued treatment through a catheter, a thin tube guided inside the blood vessels.

The report gives the following sequence, although it does not state the calendar date of the stroke:

• About six hours after symptoms began: assessment documented left limb weakness, facial weakness and an NIHSS score of 6.
• Seven hours after symptoms began: arterial puncture marked the start of catheter treatment under general anesthesia.
• During the procedure: 90 seconds of suction failed to reopen the artery, prompting the switch to SAIL.
• Immediately after SAIL: her NIHSS score improved to 2.
• At discharge: her NIHSS score was 0.
• At 90 days: both her neurological assessment and disability assessment scored 0.

The seven-hour interval included the transfer between hospitals. Her subsequent recovery reinforces the practical reason to seek emergency care promptly: doctors need time to assess the brain, identify the blockage and choose an appropriate treatment.

How Sjögren's syndrome entered the diagnosis

Ms. Wu told clinicians she had experienced dry eyes, a dry mouth, and pain and stiffness in the small joints of both hands for four years. Tests during her assessment supported a diagnosis of primary Sjögren's syndrome.

Sjögren's is an autoimmune disease, meaning the immune system mistakenly attacks the body's own tissues. It commonly affects glands that produce tears and saliva. In some people, it also affects other organs, including blood vessels supplying the brain.

Her blood tests were positive for anti-SSA and anti-SSB antibodies. A Schirmer test, which measures tear production using a small strip, recorded 4 millimeters of wetting in one eye and 5 millimeters in the other over five minutes. The authors combined the anti-SSA result with the tear test to reach the classification score required under the 2016 American College of Rheumatology and European League Against Rheumatism criteria.

Imaging of her salivary glands also showed impaired function. Later magnetic resonance angiography revealed narrowing in multiple arterial segments and irregular vessel edges, findings the treating team considered consistent with vasculitis, or inflammation of blood vessel walls.

Why the artery itself changed the procedure

Vasculitis can make an artery's wall swollen, thickened and fragile. The space through which blood flows becomes narrower, and clotting can develop at the inflamed site. Treatment must therefore address a damaged passage as well as any material obstructing it.

Yen explained that repeated pulling inside an inflamed artery may increase the risk of injury. The academic report describes possible complications including a tear in the vessel wall, perforation or rupture. A permanent stent can also become a site of fresh clotting in an actively inflamed artery.

After the initial suction attempt failed, the team suspected an underlying inflammatory artery disorder and changed tactics. Rather than repeatedly trying to extract a clot, doctors used a temporary device to support the narrowed segment while delivering medication locally.

What the temporary scaffold and medication did

The team passed a microcatheter across the obstruction and deployed a Solitaire X device measuring 3 by 20 millimeters. Although designed as a retrievable stent, it served here as a temporary scaffold, holding open a channel across the affected segment.

Through the microcatheter, doctors infused 0.5 milligrams of tirofiban over 10 minutes. Tirofiban reduces the ability of platelets, the blood cells involved in clot formation, to stick together. In this procedure, medication and temporary support worked together to help blood pass through the obstructed artery.

The device was then gently enclosed back inside the catheter rather than left permanently in place. Angiography, an examination that uses contrast dye to show blood vessels, confirmed complete restoration of blood flow. The result was graded mTICI 3, the highest category on the scale used to assess restored circulation after this type of procedure.

Mild focal narrowing remained. Doctors continued tirofiban intravenously in intensive care for 24 hours and started aspirin and clopidogrel at hour 18 to maintain protection against platelet aggregation as the infusion ended.

The paper describes SAIL as a possible option when permanent intracranial stenting is unsuitable. Its proposed advantage in this setting is temporary support with less mechanical stress on a fragile artery, while avoiding an implanted device.

Recovery required treatment beyond reopening the vessel

Ms. Wu's neurological score improved from 6 to 2 immediately after SAIL. An MRI the following day still showed an area of acute infarction, meaning brain tissue had been injured by the interrupted blood supply, in the right frontal and temporal region.

She moved from intensive care to a general ward on the second day after the procedure. A week of inpatient rehabilitation and observation followed before discharge with an NIHSS score of zero.

The rheumatology team also treated the underlying immune disease. She received high doses of glucocorticoids and azathioprine to suppress the inflammation threatening her brain vessels, with hydroxychloroquine continued as background therapy. Reopening the artery restored circulation; immune treatment addressed the process that had damaged the vessel.

Follow-up visits were scheduled weekly during the first month, then every three months. At 90 days, her NIHSS and modified Rankin Scale scores were both zero. The latter measures disability after stroke, with zero indicating no symptoms. The hospital said walking, limb movement and speech had returned to normal, and work and daily activities were unaffected.

Repeat angiography showed mild residual narrowing near the treated middle cerebral artery segment. Continued monitoring therefore remained part of her care even after her functional recovery.

How rare was the case, and what was the first?

The authors place Ms. Wu's illness among the uncommon complications of Sjögren's syndrome. They cite the French Assessment of Systemic Signs and Evolution in Sjögren's syndrome cohort, in which 5 of 392 patients, or 1.28%, had cerebral vasculitis during approximately three years of follow-up. Blockage of a major brain artery is a rarer presentation within that complication.

Kuang Tien said its literature search identified the case as the first successful endovascular treatment reported for a large vessel stroke caused by Sjögren's associated vasculitis. The paper's introduction makes a more specific claim: the first reported successful use of SAIL for an acute right M1 blockage associated with this disease. Other sections use broader wording about endovascular thrombolysis.

The most precise description of the achievement is therefore the successful use of SAIL in this particular setting. The authors call for prospective registries and studies involving multiple hospitals to help determine which patients should receive such treatment and how its risks compare with other approaches.

The report brings together emergency neurology, neuroradiology and rheumatology. Its central clinical lesson is that the cause of an arterial blockage can change the safest way to reopen it, especially when an inflamed vessel fails to respond to an initial clot removal attempt.

The patient's message and the warning signs

Ms. Wu described her experience in the patient perspective section of the academic paper. Speaking as the person who underwent the stroke and treatment, she recalled failing to recognize the symptoms at first:

I never imagined that I could have a stroke at such a young age. When my symptoms first appeared, I did not realize they were signs of a stroke.

She also wrote that learning about the connection between autoimmune disease and stroke changed her understanding of her illness. After recovery, she became more conscious of her health, the possibility of another stroke and the need for continued follow-up and disease control.

Kuang Tien's stroke center advises people to check three simple actions when stroke is suspected: smile, raise both arms and say hello. A suddenly uneven face, weakness on one side or unclear speech should prompt an immediate call to 119, Taiwan's emergency number.

The hospital also urges families to record when symptoms began and tell emergency staff about medical conditions, especially autoimmune diseases such as Sjögren's. Those details help clinicians judge both the available treatment time and the possible reason for the blockage. A person who can still stand or walk needs urgent assessment if sudden stroke symptoms appear.

Key Points

• A 46-year-old woman in Taichung suffered a complete right middle cerebral artery blockage attributed to Sjögren's associated vasculitis.
• An initial suction attempt retrieved no appreciable clot and failed to restore blood flow.
• Doctors used SAIL, combining a temporary retrievable scaffold with locally delivered tirofiban, to reopen the artery.
• She had no detected neurological deficits at discharge and no symptoms or disability on formal assessments at 90 days.
• Mild arterial narrowing remained, and treatment included immune suppression and continued follow-up.
• The July 30, 2026, case report describes the first reported successful SAIL treatment in this specific disease setting.
• Sudden facial weakness, arm weakness or unclear speech requires immediate emergency care, even when a person can still walk.