D2D Report – Antonio Ciacciarelli

During the last week of June, I had the privilege of participating in the ESO Department-to-Department Programme at UZ Leuven, Belgium, under the outstanding mentorship of Professor Jelle Demeestere. As part of the ESO Emerging Leaders Programme, this experience was far more than an observership. It was an inspiring opportunity to exchange ideas, compare different healthcare systems, and learn from one of Europe’s leading comprehensive stroke centres. From the very first day, I felt warmly welcomed by the entire team. What impressed me most was not only the clinical excellence but also the enthusiasm, kindness, and collaborative spirit shared by everyone involved.

The stroke service at UZ Leuven is very well organised. The unit consists of five acute stroke beds and twenty post-stroke beds, five of which are continuously monitored. Patients are admitted to the acute stroke unit, stabilised, and then transferred to the post-stroke ward for further management. Every step of the patient’s journey is carefully coordinated by a multidisciplinary team including stroke neurologists, stroke nurses, physiotherapists, occupational therapists, speech therapists, psychologists, dietitians, and many other healthcare professionals.

It was inspiring to see how each professional contributes to providing comprehensive, patient-centred stroke care. Another aspect that I found particularly interesting was the structured approach to goals of care and Do-Not-Resuscitate (DNR) decisions. The use of clearly defined DNR levels provides a transparent, respectful, and patient-centred framework for discussing treatment limitations with patients and their families. Coming from a healthcare system where these conversations are often less structured, I found this approach remarkably thoughtful and humane.

The centre manages an impressive spectrum of cerebrovascular diseases, including acute ischaemic and haemorrhagic stroke, subarachnoid haemorrhage, cerebral venous thrombosis, cerebral amyloid angiopathy, and many other neurovascular disorders. The close collaboration between the emergency department, neuroradiology, neurosurgery, and neurology allows patients to receive rapid and highly specialised care.

The acute stroke pathway is extremely efficient. The CT scanner is located immediately adjacent to the Emergency Department, allowing for extremely rapid imaging and treatment. Intravenous thrombolysis is administered by dedicated stroke nurses, enabling an efficient workflow. The interventional neuroradiology service is equally remarkable, with two biplane angiography suites dedicated to neurovascular procedures. I had the pleasure of observing Professor Jo Peluso, whose exceptional technical expertise is matched by his willingness to teach and mentor visitors. Besides mechanical thrombectomy, the team performs a wide variety of advanced neurointerventional procedures, including intracerebral aneurysms, spinal vascular malformations, middle meningeal artery embolisation, and many other complex interventions.

The academic environment is very impressive. The department is highly structured, with medical students, residents, fellows, PhD students, and consultants all working together in a stimulating atmosphere that strongly promotes education and research. Throughout the week, I attended multidisciplinary clinical and research meetings, highlighting the close integration between clinical practice and scientific innovation. Research is clearly one of the department’s greatest strengths. PhD students are fully dedicated to cerebrovascular research and actively contribute to international clinical trials, investigator-initiated studies, and innovative projects. Their passion for advancing stroke care was truly contagious.

I also had the opportunity to attend the Belgian Stroke Council National Stroke Care Meeting. It was fascinating to see clinicians, researchers, healthcare administrators, and policymakers working together with the common goal of improving stroke care at a national level. It reminded me how important collaboration between medicine and health policy is for building better healthcare systems.

Beyond stroke, one of the most memorable learning experiences was discovering the department’s expertise in spontaneous intracranial hypotension (SIH). Their multidisciplinary collaboration with neuroradiologists has created a highly specialised diagnostic and therapeutic pathway for this often under-recognised condition. I was impressed by their dedicated outpatient clinic, where patients are referred from across the country, reflecting the team’s unique expertise and commitment to this fascinating field.

At the end of this week, I return home with much more than new clinical knowledge. I bring back new ideas, different perspectives, valuable friendships, and the conviction that excellence in stroke care is built upon a well-organised multidisciplinary system, strong leadership, continuous research, and, above all, motivated people who enjoy working together. I would like to express my sincere gratitude to Professor Jelle Demeestere for his mentorship and generosity throughout my visit. My heartfelt thanks also go to Robin Lemmens, Anke Wouters, Jo Peluso, and every member of the UZ Leuven Stroke Team for making me feel part of their department from day one.

Finally, I would like to thank the European Stroke Organisation for supporting young stroke physicians through the Emerging Leaders Programme and the Department-to-Department Programme. Experiences like this are invaluable, and I am certain that what I learned in Leuven will positively influence my clinical practice and help improve stroke care in my own institution.

Are you an early-career stroke professional looking to develop your leadership skills, expand your international network and drive change in your own country? Applications for the ESO Emerging Leaders Programme are now open until 31 August 2026.

Learn more and apply now.