Endovascular Stent-Assisted Intracranial Lysis for Acute Middle Cerebral Artery Occlusion in a Young Woman with Primary Sjögren’s Syndrome: Case Report

Pao-Sheng Yen,1 Victor C Kok,2 Shang-Chang Ho,3 Yu-Hui Lin,3 Yu-Tzu Wu,3 Guo-Dung Hung41Department of Neuroradiology, Kuang Tien General Hospital, Taichung, 433004, Taiwan; 2Department of Internal Medicine, Kuang Tien General Hospital, Taichung, 433004, Taiwan; 3Department of Neurology, Kuang Tien General Hospital, Taichung, 433004, Taiwan; 4Department of Rheumatology and Immunology, Kuang Tien General Hospital, Taichung, 433004, TaiwanCorrespondence: Guo-Dung Hung, Department of Rheumatology & Immunology, Kuang Tien General Hospital, N O. 127, Sec. 7, Xiangshang Road, Shalu Dist, Taichung, 433004, Taiwan, Email [email protected]: Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of exocrine glands, with potential extra-glandular manifestations including central nervous system vasculitis. Ischemic stroke resulting from pSS-associated vasculitis is rare, and large vessel occlusion (LVO) in this setting poses a significant therapeutic challenge. The inflamed vessel wall is inherently fragile, rendering it susceptible to iatrogenic dissection or rupture when subjected to the mechanical forces of standard thrombectomy devices or permanent intracranial stenting. We report a case of pSS presenting with acute ischemic stroke secondary to right M1 large vessel occlusion. Successful revascularization was achieved using the Stent-Assisted Intracranial Lysis (SAIL) technique. We highlight the procedural nuances of employing a temporary stent-retriever scaffold to minimize mechanical trauma to an inflamed vessel wall and demonstrate that this approach may yield favorable functional outcomes even in settings where permanent intracranial stenting is contraindicated.Keywords: Sjögren’s syndrome, acute ischemic stroke, endovascular thrombectomy, EVT, SAIL technique, case report