Bulgaria has had a stroke every 11 minutes. From January to July 2026, the National Health Insurance Fund (NZOK) recorded 26,758 cases. Prof. Dr Dimitar Maslarov, a board member of the Brain Health Council Foundation, presented the figures.

The foundation held a round table, "Artificial Intelligence and Stroke – From the First Minutes to a New Life", to mark World Stroke Day on 29 October. Speakers discussed what stroke costs patients, society and the health system, and what role artificial intelligence plays after prevention and during the stroke itself. A calculator that estimates the risk of stroke over the next five years was also shown at the meeting.

Cases have fallen over the past 10 years, from 51,986 in 2016 to 43,006 in 2025. "I have moderate optimism that strokes in Bulgaria are going down," Prof. Maslarov said.

Cerebrovascular diseases cause one in six deaths in Bulgaria, four times the EU average. One in four people admitted to hospital with an acute stroke is aged between 18 and 64. Seven in ten of those who die are men. In rulings by the TELK medical expert commissions, the after-effects of stroke are the number one diagnosis.

Arkadi Sharkov, from the foundation's board, presented a study which found that cerebrovascular diseases cost the health fund, households and the economy €472m a year. The fund pays 15%, households 32% and the economy 52%. Patients themselves pay for 78% of post-stroke medicines, the highest share among common diseases. The study used data from Eurostat, NZOK, the National Centre of Public Health and Analyses, the National Health Information System, the National Statistical Institute and the National Social Security Institute, as well as the authors' own calculations.

The National Programme for Ischaemic Stroke provides for six high-tech centres: three in Sofia and one each in Pleven, Plovdiv and Varna. Seventeen regional hospitals will get special equipment and a shared digital platform. Artificial intelligence is part of the programme.

Ischaemic stroke is the hardest to organise treatment for, said Assoc. Prof. Dr Nikolay Velinov, head of the adult neurosurgery department at the Pirogov emergency hospital. The reason, he said, is that a long diagnosis comes before the treatment room. Patients arrive late, he said, because of the long journey to the centre where the procedure is done, slow recognition and triage, and a slow "door-to-puncture" time.

On average, 311 minutes pass before treatment. In hospitals that use artificial intelligence software, this time has fallen by 23%. Velinov said this means patients spend less time in hospital and more people get care.

Prof. Maslarov presented a three-level brain health strategy. Before a stroke, it relies on early prevention, education and risk control. During a stroke, it depends on the 112 emergency number, fast triage, remote consultation with the help of artificial intelligence, and special teams. After a stroke come rehabilitation, follow-up at home and long-term prevention.

A stroke does not start in the hospital, Maslarov said. In treatment data, he said, what matters more is how many patients got timely access to care and what the outcome was, not just how many procedures were done. Part of the problem is that access differs depending on where people live.

The foundation proposes a digital network with shared protocols, transport, specialised teams and remote consultations. It is built on six steps: prevention, recognition, diagnosis, treatment, recovery and follow-up.

In Berlin, Maslarov said, three ambulances worth one million each are fitted with a mini scanner with artificial intelligence. The scanner makes the diagnosis in the ambulance, and treatment starts there. Maslarov put the goal this way: fewer people with disabilities, memory and thinking kept intact, active longevity and less burden on families and the system.

A new clinical pathway for transient ischaemic attack, a brief disruption of blood flow in the brain, comes in this year. Maslarov gave it as an example of a good change. He said the clinical pathway for stroke now covers more than acute cases, and that this is a result of the foundation's efforts.