Status epilepticus of carotid web after carotid artery stenting: A case report

Carotid web, a special vascular lesion, has been increasingly recognized as a significant etiology of ischemic stroke. Unlike traditional atherosclerosis, carotid web is a linear intraluminal protrusion with a free edge that oscillates with blood flow, leading to blood flow stagnation and thrombus formation. These pathophysiological features lead to the high risk of stroke recurrence and certain association with large-vessel occlusion. Given these, carotid artery revascularization has been recommended as an optional treatment for carotid web. We herein described a case of a patient with ischemic stroke and carotid web who eventually underwent carotid artery stenting after recurrent ischemic attacks during hospitalization. However, the patient developed status epilepticus postoperatively. Repeated magnetic resonance imaging revealed an enlarged infarction, whose location was consistent with the territory of the anterior cerebral artery. Regarding therapy, intravenous infusion of sodium valproate successfully terminated the status epilepticus secondary to stroke, providing an alternative when clinicians are concerned about the depression of diazepam. Subsequent oral antiseizure medications were required and newer-generation agents (e.g. levetiracetam, lacosamide, zonisamide, and topiramate) were increasingly recommended due to their neutral impact on secondary stroke prevention.