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Endovascular Treatment of Ischemic Stroke in "St. Marina" – Varna Saves Patients’ Lives

The timely response, up to the 6th hour, and the endovascular (intravascular) treatment of ischemic stroke gives patients a tremendous chance of life. This was announced today by Prof. Dr. Silva Andonova – a National Consultant on Neurology and Head of the Second Clinic of Nervous Diseases at "St. Marina" University Hospital in Varna. The cost of treatment, which involves brain clot removal or placing a stent, has been paid entirely by the Ministry of Health since June 2016. The high-tech manipulations are a part of the multidisciplinary approach and can be performed only in an authorized hospital. The press conference was attended also by Prof. Dr. Ara Kaprelyan - Head of the First Clinic of Nervous Diseases, Prof. Dr. Yavor Enchev - Head of the Clinic of Neurosurgery, Assoc. Prof. Dr. Tony Avramov and Dr. Chavdar Bachvarov, who are a part of different units at the University Hospital.

The implementation of the multidisciplinary approach in patients with acute ischemic stroke results in reducing mortality and disability, and a better clinical outcome of the disease.

Measures have been set down to improve the quality of care for patients with acute stroke. In 2012 a meeting was initiated with the management of the Center for Emergency Medical Care (CEMC) on the new possibilities of treating patients with acute ischemic stroke and the need for their rapid transportation to a hospital. The meetings with CEMC teams from Varna and the region have been held annually, and the doctors and dispatchers are trained for rapid and accurate diagnosis of eventual stroke, a training of CEMC teams focused on  assessing the degree of a focal point of neurological symptoms is conducted, while at the same time in the course of their continuous postgraduate training they are acquainted with other therapeutic options and innovative methods in the treatment of acute ischemic stroke, including endovascular treatment in the acute stage of the disease by leading neurologists from the clinic as well. As a result of the continuous meetings and training of the staff from the different units, as well as the regular meetings with CEMC teams, the number of patients with acute ischemic stroke treated with intravenous thrombolysis has increased over the years. Following the issue of the Order of the Minister of Health № RD. 01.213 / 28.06.2016, which allowed the provision of medical devices for interventional treatment of acute ischemic stroke, which are not paid for by NHIF budget, and the adoption in 2016 of the National Consensus for Mechanical Thrombectomy in Acute Ischemic Stroke, the Bulgarian citizens, hospitalized with acute stroke in the respective hospitals, which meet the criteria for performing interventional treatment, have the opportunity to receive adequate and quality treatment as the rest of the EU citizens. Unfortunately, the percentage of recanalization procedures (vessel emptying) - intravenous thrombolysis, thrombectomy in Bulgaria remains low between 2% and 5% compared to the centres for treatment of stroke in the Western European countries, where recanalization procedures have been performed in 20% to 30% of those hospitalized with acute stroke.

It is necessary to introduce effective management and coordination of the activities not only at hospital but also at regional level; creating institutional capacity for timely implementation of the existing standards for treatment of patients with acute ischemic stroke.

The organization of medical care and, above all, the consistent implementation of the various stages of care pre-hospital phase, hospital phase - diagnosis and treatment in the acute phase, secondary prevention and early rehabilitation are of crucial importance either.

The rapid recognition of acute stroke symptoms by the patient himself or his relatives is essential, the immediate contact with the Centres for Emergency Medical Care (CEMCs), and the rapid transportation to a specialized acute stroke treatment centers. The main difficulties in the treatment of patients with acute ischemic stroke in Bulgaria are related to the late hospitalization of patients, the uneven distribution of acute stroke treatment centers in the country (only in the urban areas), the presence of only several centres for recanalization procedures due to the lack of trained personnel. The emphasis should be placed on training: training of CEMC teams, training of the medical staff, directly involved in the treatment of patients with stroke, training of the members of the multidisciplinary team of specialists in hospital and pre-hospital medical care, training of patients and their families.