When I joined the ESO Emerging Leader Programme in 2024, I set out to address an important gap in stroke and cerebrovascular care in Bulgaria: the limited awareness and under-recognition of cerebral amyloid angiopathy (CAA). Three years later, the programme has helped transform this idea into a growing national initiative while providing invaluable opportunities for learning, collaboration, and professional development.

CAA is a common cerebral small vessel disease and a major cause of lobar intracerebral haemorrhage and cognitive decline. Despite its clinical importance, Bulgaria lacked a dedicated registry, referral pathways, and coordinated expertise in this field. My project, “Virtual Hospital for Patients with Cerebral Amyloid Angiopathy in Bulgaria,” aimed to establish the foundations for a national system supporting the diagnosis, management, and research of CAA.

One of the first steps was conducting a nationwide survey among Bulgarian healthcare professionals to assess current knowledge and clinical practice. The results revealed significant challenges in awareness, diagnostic confidence, and access to specialised investigations, highlighting the need for a coordinated national approach.

Building on these findings, we established a multidisciplinary expert network bringing together neurologists and neuroradiologists to discuss complex cases and provide recommendations for diagnostic evaluation and management. We also began developing the first national CAA registry in Bulgaria, creating a foundation for future research and improved patient care.

The ESO Emerging Leader Programme played a crucial role in shaping this project. Participation in the ESO Edinburgh Stroke Research Workshop helped refine the initial concept, while the ESO Focused Workshop on CAA and a Department-to-Department observership at the Carlo Besta Neurological Institute in Milan provided valuable clinical and research experience. These opportunities allowed me to learn from leading European experts and gain insight into multidisciplinary approaches for rare cerebrovascular diseases.

Beyond the project itself, the programme offered numerous opportunities for leadership development and international collaboration. Through ESO working groups, webinars, guideline activities, and interactions with fellow Emerging Leaders, I developed new skills in scientific communication, networking, and collaborative research. Some of the most rewarding outcomes have been the lasting professional relationships and multinational collaborations that continue beyond the programme.

One of the biggest challenges was building awareness for CAA to many healthcare professionals in Bulgaria. Establishing new pathways and networks required engagement across multiple institutions and specialties. However, this challenge also became one of the most fulfilling aspects of the project, demonstrating how collaboration can drive meaningful change.

Looking ahead, the next steps include expanding the national registry, strengthening multidisciplinary consultations, and further integrating Bulgaria into international research initiatives focused on cerebral small vessel diseases. My ultimate goal is to improve the recognition and management of CAA while ensuring that patients have access to specialised expertise and evidence-based care.

I am deeply grateful to the European Stroke Organisation, the Emerging Leader Programme, and my mentor, Professor Anna Bersano, for their guidance and support throughout this journey. The experience has reinforced my belief that progress in healthcare is built through collaboration, education, and a shared commitment to improving patient outcomes.

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.

The ESO EAST Steering Committee organised the 12^th ESO EAST Workshop, with support from the ESO Head Office. The 12th ESO EAST Workshop was held on 5 May 2026 in Maastricht, the Netherlands, traditionally organised a day before the European Stroke Organisation Conference.  It followed the Joint Stroke Action Plan for Europe National Coordinators (SAP-E NC) & ESO EAST Meeting and gathered ESO EAST Country Representatives, the ESO EAST Steering Committee, ANGELS Initiative representatives, the RES-Q team, ESO Head Office representatives, invited guests, and industry partners.

The programme focused on key developments in stroke care across the ESO EAST region, with mainly sessions structured around an introductory presentation followed by country experiences and discussion.

The first session, chaired by Dmytro Lebedynets and Alexandras Vilionskis, addressed mechanical thrombectomy issues in the region, focusing on training and implementation. An introductory presentation by Dmytro Lebedynets, based on the ESO EAST survey, provided an overview of current practices and challenges, followed by country presentations illustrating different stages of development and service organisation.

This was followed by the RES-Q registry session, chaired by Cristina Tiu and Robert Mikulik. Robert Mikulik opened the session with an overview of new developments in the RES-Q registry, with a particular focus on intracerebral hemorrhage (ICH) and quality monitoring. Country contributions highlighted experiences with implementing ICH guidelines in clinical practice.

The session on emerging leaders in stroke, chaired by Alexander Tsiskaridze and Hrvoje Budinčević, presented selected projects reflecting ongoing innovation in the region. Presentations by Marieta Peycheva and Rytis Masiliūnas demonstrated approaches to improving stroke care through digital solutions (virtual hospitals) and national system-level initiatives.

The final session, chaired by Zuzana Gvodinova and Michal Karlinski, focused on neurorehabilitation. Michal Karlinski introduced the session with results from the ESO EAST survey, followed by country presentations addressing current practice and remaining gaps in achieving optimal standards of care in neurorehabilitation.

Discussions were conducted in an amicable, constructive atmosphere, continuing the long-standing tradition of collaboration within the ESO EAST community.

Learn more about ESO EAST

In November 2025, I had the honour of visiting St. George’s Hospital in London as part of the ESO Department-to-Department (D2D) programme. For four weeks, I worked in the Hyper Acute Stroke Unit (HASU) and had the opportunity to observe its daily workflow, participate in clinical discussions, and learn from a highly organised multidisciplinary team.

The HASU has 20 beds, and every morning the team – including neurologists or geriatricians, residents, nurses, physiotherapists, nutritionists, and speech therapists – meets for a structured pre-ward round discussion. Each member documents important clinical, laboratory, and radiological information for all patients. After this meeting, doctors review updated imaging and laboratory results, while a neuro-radiologist joins the team on Mondays to discuss CT and MRI findings. During the ward round, patients are examined, results are reviewed at the bedside, and family members are informed about the treatment plan. After the round, the team discusses new information and finalises the plan for investigations and treatment.

What impressed me most was the high level of involvement of junior doctors and residents in every stage of patient care. Each team member has a clearly defined role, from the emergency department through discharge, which ensures smooth coordination and efficient workflow. The thrombolysis call system is another strength of the unit. When the on-call team receives the alert, two residents and one stroke nurse arrive in the Emergency Department within 10 minutes. Their actions follow clear protocols and are supervised by the on-call neurologist, contributing to a rapid door-to-needle time

After returning to Georgia, I delivered a presentation to my department about the HASU model, which does not currently exist in our healthcare system. I explained how the unit is organised, how daily work is structured, and how thrombolysis is managed in a timely manner. I emphasised that neurologists and geriatricians are directly involved in interpreting neuroimaging and making important treatment decisions, while in my country, we are more dependent on the radiology team for these evaluations. I also discussed differences in acute stroke management, secondary prevention strategies, and ongoing stroke research at St. George’s Hospital. My colleagues asked many questions, which showed their interest and
eagerness to improve stroke care.

Overall, this experience strengthened my clinical skills and deepened my understanding of stroke care organisation. It inspired me to apply some of these practices in my home institution, particularly regarding structured teamwork, efficient thrombolysis, and multidisciplinary collaboration. I am grateful to ESO for this opportunity and to the entire HASU team for their openness and support. I would like to especially thank my supervisor and Head of Department, Dr Anthony Pereira, for guidance and encouragement during my stay.