Dr. Borislav Borisov: Thrombolysis is a chance for people with a stroke to stay alive

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Dr. Borislav Borisov: Thrombolysis is a chance for people with a stroke to stay alive
Dr. Borislav Borisov: Thrombolysis is a chance for people with a stroke to stay alive

Every year on September 29, we celebrate World Heart Day to remember how widespread and dangerous cardiovascular diseases are. Between 13 and 15 thousand cases of heart attacks are registered in our country every year, and nearly 6 thousand people die from acute myocardial infarction, according to the data of the Society of Cardiologists in Bulgaria

The statistics in our country are startling - every two out of three deaths are from cardiovascular disease such as myocardial infarction, ischemic heart disease, stroke, heart failure. This is the most common socially significant group of diseases in our country, because it causes the death of over 70 thousand people per year out of a total of over 100 thousand Bulgarians who died during the year. These are the official statistics of NSI and the Ministry of He alth. According to cardiologists, 80% of these premature deaths could have been prevented. A he althy diet, regular exercise and abstinence from smoking, control of blood pressure, blood sugar, blood cholesterol levels are necessary.

On this occasion, we are talking to the head of the Cardiology Department at the University Hospital in Stara Zagora, Dr. Borislav Borisov. He has two speci alties - internal medicine and cardiology and is one of the established specialists in invasive cardiology in our country.

Dr. Borisov, cardiovascular diseases are the reason for the high mortality rate worldwide. Is the percentage higher in Bulgaria compared to other countries?

- Cardiovascular disease as a persistence is indeed a cause of high mortality throughout the developed world. We are no exception, but I would not say that we are champions in this regard. Of course, there is still a lot to do to move down the rankings and catch up with countries like Belgium and France, where the death rate is much lower. More importantly, there the age limit of deaths from cardiovascular diseases has been shifted upwards, while in our country, unfortunately, mortality is observed at a younger age. In this aspect, a serious emphasis should be placed on prevention, i.e. lifestyle and avoidance of risk factors: smoking, serious control of blood sugar, cholesterol, blood pressure and, last but not least, obesity, which in general is a kind of epidemic.

Are we falling behind more developed countries in treatment options for these diseases?

- In Bulgaria, the percentage of smokers is particularly high - about 30%, and in the USA this percentage is 17, i.e. twice as low. Smoking is indeed one of the most serious factors in the development of cardiovascular diseases. In terms of treatment options for these diseases, I think we are not far behind. According to Eurostat data, although we have a much lower budget for he althcare compared to the Czech Republic, the death rate in our country is exactly the same as theirs. Currently, in our hospital, together with the Department of Neurology, we are building a system for joint work with the Center for Emergency Medical Assistance. I hope that very soon this system will significantly reduce both disability and fatality in strokes, the rate of which is now very high.

How important is the first reaction of others when a person has a heart attack or stroke?

- In all emergency situations, it is extremely important to react in time and at the first appearance of any suspicious symptoms to immediately

seek help in emergency rooms

The earlier the most modern treatment methods are applied, the better the results and the fewer the consequences. With regard to medicines, the nomenclature we have in Bulgaria is in no way inferior to what is used all over the world. But there is still a lack of mass awareness that he alth care is our own mission. Avoiding risk factors is the best prevention.

You recently saved a 77-year-old woman with ischemic stroke by local fibrinolysis. In what cases can this method be applied?

- We have a perfect organization regarding the administration of thrombolysis if the patient is transported to the Emergency Department of the hospital within the first 3 hours of receiving the stroke. We need a reference time between 30 minutes and 1 hour to diagnose the patient's condition, perform the necessary blood tests and scan. Thus, up to 4 and a half hours from the onset of the disease, we have the opportunity to include patients in thrombolysis mode, monitoring their condition through control monitors.

For which patients is thrombolysis suitable?

- The treatment is only given to patients who have had an ischemic stroke - when a thrombus has blocked a cerebral blood vessel. The active substance begins to act immediately to break up the thrombus and unclog the blood vessel. The patient's symptoms usually improve within the first hour. Under favorable circumstances, up to 24 hours after thrombolysis treatment, more than 70% recovery of stroke lesions can be achieved. Success is not always so good, but still thrombolysis is a chance for stroke patients to stay alive and not become disabled.

And what success did you achieve with your patient from Yambol?

- The 77-year-old woman from Yambol that you mentioned, who was transported to the hospital within the third hour of the stroke, also had a very good result. She was admitted as an emergency with a completely immobile left leg and arm, as a result of the stroke. The condition implied a serious risk to the patient's life, but the quick diagnosis and transportation along the 100-kilometer section between Yambol and Stara Zagora allowed us to apply the most modern treatment for such conditions. The patient was admitted to the Emergency Department by Dr. Issam Al-Attar and brought to the angiography room in just 8 minutes. We penetrated to the site of the blockage through special catheters through an artery in the patient's leg, reaching the problematic cerebral artery. We used the special subtraction function of the angiographic apparatus, which gives a detailed image of the vessels, suppressing the signal from all other structures - bones, soft tissues. We performed superselective fibrinolysis by injecting a relatively small amount of fibrinolytic. We unblocked the artery in no time. In comparison, if venous fibrinolysis is performed, the amount of fibrinolytic used will be much larger, and its injection will be longer and, respectively, more damage will be allowed as a result of the stroke.

In the very first scan done on the patient the day after the procedure, we saw a very good result. The 77-year-old woman now moves her two left limbs normally, which were completely immobile before the treatment, and even feeds herself. All of this is very gratifying for the entire team that took on her case.

Are there any patients who are not suitable for thrombolysis treatment?

- No, every stroke patient is suitable for thrombolysis. The patient must not have had any other bleeding, for example from an ulcer, in the last 3 months. He must not have experienced another stroke in time. If he maintains very high blood pressure, above 180/100, thrombolysis can be performed only after it is under control. The patient must not have experienced serious trauma in the last 3 months, and must not have been on anticoagulant therapy. Therefore, only doctors can judge in which specific case the application of thrombolysis is appropriate.

What goal do you set as professionals to improve the treatment of stroke patients?

- The goal of our hospital is to give all stroke patients a chance to be treated properly to minimize mortality and disability and to receive treatment at a European level. Just recently, my whole team and I were on training in Ljubljana at just such an interventional treatment center.