Encouraging proactive risk assessment for strokes must be a key priority: a simple neck artery scan, guided by the individual’s risk profile, can be the difference between identifying a silent threat early and discovering it only after disability strikes
The most effective protection against stroke continues to be disciplined control of blood pressure, cholesterol, and diabetes; quitting smoking; regular physical activity; and maintaining a healthy body weight File photograph used for representational purposes only
Brain strokes continue to remain one of the most alarming public health challenges in India. As a neurologist who sees the devastating consequences daily, it is evident to me that many strokes need never have happened. Strokes are the final event in a long, silent process—one that we now have the tools to detect, slow down, and often prevent.
Overlooked risk factor
One of the most overlooked contributors to stroke risk lies not in the brain, but in the neck. The carotid arteries, which carry blood to the brain, can gradually narrow due to the build-up of fatty plaques. This process is often completely symptom-free. Yet when a plaque ruptures or a clot forms, blood flow to the brain can suddenly stop, leading to irreversible paralysis, loss of speech, or even death.
Recently, an important international study, the CREST-2 trial, offered new clarity on how we can better protect people at risk. The study followed more than 2,400 individuals with severe but symptom-free carotid narrowing. All participants received the best possible medical therapy—including strict control of blood pressure, cholesterol, and other vascular risks. However, the findings showed something crucial: those who also underwent carotid stenting had nearly half the risk of stroke or early death over four years compared with those treated with medicines alone.
This does not mean that every individual with carotid disease requires an intervention. What it does reinforce, however, is that early identification of severe carotid narrowing provides an opportunity to offer additional protection to those who truly need it. Timely diagnosis makes the difference between silent risk and preventable tragedy.
Tools available
One of the simplest tools available to us is the carotid Doppler ultrasound. This non-invasive test uses sound waves—without any radiation—to assess plaque build-up and measure how much the artery has narrowed. It is quick, painless, widely available, and remarkably informative.
While it is not recommended indiscriminately for everyone, it can be immensely useful for individuals with multiple stroke risk factors. These include high blood pressure, diabetes, elevated cholesterol levels, smoking, heart disease, peripheral artery disease, or a strong family history of vascular events. For adults above 50–55 with such risks, adding a carotid Doppler scan to an annual health check can help unearth silent but dangerous blockages long before they cause harm.
Focusing on the basics
Of course, no scan replaces the basics. The most effective protection against stroke continues to be disciplined control of blood pressure, cholesterol, and diabetes; quitting smoking; regular physical activity; and maintaining a healthy body weight. These lifestyle foundations remain our strongest defense.
At the same time, we must remember the signs that need urgent medical attention. Sudden weakness, facial drooping, slurred speech, vision loss, or sudden imbalance should always be treated as a medical emergency. These brief, transient episodes—often called warning strokes—may be the first indication of significant carotid disease and represent a narrow window to prevent something far more catastrophic.
As we work toward strengthening India’s stroke-preparedness ecosystem, encouraging proactive risk assessment must be a key priority. A simple neck artery scan, guided by the individual’s risk profile, can be the difference between identifying a silent threat early and discovering it only after disability strikes. Stroke prevention is not only possible—it is within reach, if we act n time.
(Dr. Vikram Huded is senior consultant, director, and clinical lead, interventional neurology programme, Narayana Health, Bengaluru. vikram.huded.dr@narayanahealth.org)
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