D2D Report — Marieta Peycheva

This report follows my one-week observership at the Istituto Neurologico Carlo Besta in Milan, Italy, under the mentorship of Dr. Anna Bersano. Earlier this year, in March, I had the privilege of attending the ESO Focused Workshop on Cerebral Amyloid Angiopathy (CAA), organised by Dr. Bersano’s team. Returning in September for this observership provided a natural and enriching continuity: the insights gained during the workshop became the foundation for the clinical experiences and impressions I developed during my stay.

From the very first day, the institute’s rich heritage and reputation were immediately evident. Founded in 1918 and officially recognised by the Italian government as an Institute of Research and Treatment since 1981, Carlo Besta Institute seamlessly blends tradition with cutting-edge clinical and research excellence. I was intrigued to learn that Newsweek ranks the institute among the world’s leading specialised neurology hospitals—a recognition that is clearly reflected in both the care provided and the quality of ongoing research.

My observership was profoundly enriched by the mentorship of Dr. Anna Bersano, whose expertise as Director of the Cerebrovascular Unit made the experience both educational and inspiring. Her generous guidance enabled me to engage fully with both the clinical and scientific dimensions of advanced cerebrovascular medicine.

The primary focus of my stay was on rare cerebrovascular diseases, including Moyamoya disease, CADASIL, and cerebral amyloid angiopathy. I was particularly struck by the meticulous care with which each patient’s journey was approached: reconstructing clinical histories, and integrating neuroimaging and biomarker insights into a cohesive diagnostic and therapeutic strategy. A defining strength of the institute is its truly multidisciplinary approach, especially in managing highly complex neurosurgical and endovascular cases. I had the opportunity to observe detailed planning and execution of treatments for arteriovenous malformations, dural fistulas, and complex aneurysms. One of the most impressive aspects was witnessing surgical treatment for Moyamoya disease, where cerebral bypass procedures offered patients renewed hope and quality of life. The seamless collaboration between neurologists, neurosurgeons, and interventional neuroradiologists was exemplary, representing an outstanding level of integration.

Equally impressive was the work of the Laboratory of Cellular Neurobiology, led by Dr. Laura Gatti. Her team conducts highly specialised investigations and in-depth biomarker analyses essential for diagnosing of cerebral small vessel diseases. Observing the precise and effective translation of laboratory science into clinical decision-making was profoundly enlightening, reaffirming the institute’s stature as a center of excellence. My daily rhythm at Carlo Besta Institute was intensive and deeply inspiring. Mornings were spent on the ward, discussing and examining patients, while afternoons were devoted to outpatient follow-ups with patients affected by rare cerebrovascular disorders. In parallel, I was able to engage with ongoing research activities, further enriching my experience.

Throughout my visit, I felt genuinely welcomed by the entire team. I am especially grateful to Dr. Benedetta Storti, Dr. Nikola Rifino, Dr. Isabella Canavero, Dr. Irene Scala and psychologists Giulia Marinoni and Carolina De Toma, who created an open, collegial, and intellectually stimulating environment. Their willingness to share knowledge and involve me in clinical reasoning processes made me feel part of the team, despite the brief nature of my stay.

I returned home with not only new knowledge but also a strong sense of connection—to the people, to the institute, and to a global community dedicated to advancing the understanding and treatment of rare cerebrovascular disorders.

With deep gratitude, I wish to thank Dr. Anna Bersano for her exceptional mentorship and leadership, as well as my colleagues for their generosity, kindness, and dedication. My week in Milan was more than a professional milestone—it was a personal inspiration. It was a true privilege to witness the highest standards of care and research in the field of rare vascular diseases.

Learn more about the Emerging Leader Programme here:

https://eso-stroke.org/resources/emerging-leader-programme/

and explore the D2D Programme here:

https://eso-stroke.org/resources/department-to-department-visit-programme/