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Modern Treatment of Stroke in Bulgaria is a Priority of the Government Health Policy

Assoc. Prof. Dr. Silva Andonova, National Consultant in Interventional Neurology:

Modern Treatment of Stroke in Bulgaria is a Priority of the Government Health Policy


Personal Card: Assoc. Prof. Dr. Silva Andonova, D.Sc., has been the Head of Second Neurology Clinic at St. Marina University Hospital since 2009 and an Associate Professor at Medical University - Varna. She is a Chief Researcher at the Centre for Research QUICK of the European Stroke Organisation (ESO), National Coordinator of the European project ESO-EAST, National Coordinator of Safe Implementation of Treatments in Stroke (SITS) International Registry. In 2015 she was a researcher in the research team of the University of Oxford - ACST-2 for endovascular treatment in patients with extracranial carotid pathology. In August 2016 she was selected as a National Consultant in Interventional Neurology pursuant to an order of the Minister of Health.

She speaks English, German, Italian and Russian languages.


Assoc. Prof. Andonova, what is stroke?


Stroke is a "brain attack". It can happen to everyone, and although the average age of those affected by it is around 65, over the recent years we have witnessed decrease of the age limit. There are two types of strokes - ischemic and hemorrhagic stroke. Ischemic stroke, which accounts for about 95% of all cases, occurs when blood circulation is suddenly interrupted due to blockage in some part of the brain. When it happens, brain cells are deprived of oxygen and start dying. Brain functions, controlled by the affected part, such as memory, speech, hand and foot movements, are lost. Haemorrhagic stroke occurs in about 15% of the cases of acute stroke. It occurs when there is a blood vessel rupture which results in collecting blood in the gray matter. Although it is less common, the treatment of hemorrhagic stroke in the acute phase is also very important because of the high mortality and severe disability that it causes.


You have recently been selected as a National Consultant in Interventional Neurology. What exactly is interventional endovascular treatment of acute stroke?

By 2015, intravenous administration of a drug dissolving the thrombus had been used for specific treatment of acute ischemic stroke, up to 4.5 hours from the onset of the symptoms in order to achieve recanalization (opening) of the blocked vessel. At the beginning of 2016, an international group of specialists adopted a consensus that set strict indications and a method of conducting another type of specific treatment, the so-called endovascular treatment, including intra-arterial thrombolysis, thrombaspiration. This type of treatment allows the place of blockage to be reached through the arterial vessel by injecting a drug onto the spot or by using a particular type of stent, which captures the thrombus and the latter is removed. This specific treatment, conducted under strict indications, shortens the hospital stay, reduces hospital mortality and increases the chances of each patient with acute ischemic stroke to feel a complete person again in the family and the society.

Endovascular treatment of brain stroke is a scientifically proven method of treatment, which has  already been applied globally. And what about Bulgaria?

In June 2016 the Ministry of Health issued an order approving a methodology intended to subsidize medical institutions, in which in addition to the way of providing medical devices for endovascular treatment of acute strokes, the specific requirements to the organizational structures, activities and human resources for the implementation of the activities of interventional treatment were determined. The order of the Minister of Health defines the criteria for the establishment of a High Technology Centre for Treatment of Acute Cerebral Insults, determines indicators for monitoring hospital care quality, emphasizing the need for patients with acute stroke, who have undergone a relevant type of specific treatment, to be included in a register of the medical establishment. I can say that modern treatment of stroke in Bulgaria is a priority of the government health policy.

How can medical establishments in the country organize their activities in order to achieve a high quality of the provided treatment in practice?

The introduced by the Ministry of Health in the order of June 2016 quality indicators for treatment of acute stroke determine the level of compliance with the standards in healthcare. To achieve high quality it is necessary to set up training centres for CEMA personnel, for the teams in the department for treating strokes, for the teams in the High Technology Centres for Treatment of Stroke, for the specialists conducting endovascular treatment, and to set training standards.  

What needs to be done so as a greater number of patients with acute stroke to have the chance to be treated with the modern methods we have just talked about?

The organization of medical aid and especially the consistent implementation of the different stages of the aid are of crucial importance - the timely transportation to the centre for treatment of acute strokes, early diagnosis and treatment in the acute phase, secondary prevention and early rehabilitation. Moreover, multidisciplinary teams at the different centres for treatment of strokes need to be set up.

In 2016 you were distinguished with "Varna" Award for making Second Neurology Clinic at St. Marina University Hospital an indispensable part of the global initiative of Safe Implementation of Treatments in Stroke (SITS), and you were the first Bulgarian Neurology Clinic to join the European register. Would you share the experience of the Clinic with the other centres?

The favorable opportunities for team work within St. Marina University Hospital and Medical University - Varna allow for better synchronization of neurological diagnostics with timely neurological and/or neurosurgical activities, as well as maintaining a high level of theoretical and practical training in the diagnosis and treatment of brain stroke by all team members through continuous training of medical specialists and health care professionals. MU-Varna organizes training courses and seminars for multidisciplinary teams. It is necessary to synchronize the activities of the various centres in the country, to unify the algorithms and protocols for treating acute stroke, to constantly maintain a good level of qualification of doctors and health care professionals in the diagnosis and treatment of patients with acute stroke. Upon request by the specialists at the centres/departments for treatment of acute stroke in Bulgaria, they can attend the training programmes at Medical University - Varna.