Over decades stroke is a leading cause of mortality and disability in Bulgaria. The country ranks first in EU in terms of stroke mortality rates according to the Health Strategy 2014–2020. Analysis of the data from recent years shows three major trends in stroke morbidity and mortality in Bulgaria: (1) As compared to 2005, the number of deaths from cardiovascular diseases in 2012 increased with 9.2/100 000 population but the death rates from stroke decreased with 19.6 per 100 000 population; (2) The number of women with ischemic stroke increased from 50.5% in 2010 to 52.7% in 2013; (3) For the same period the number of patients of both sexes with ischemic stroke under the age of 55 decreased from 9.2% to 8.1%. These trends are associated with a demographic aging process with increasing life expectancy of the Bulgarian population, improved diagnostics of cardiovascular diseases and implementation of endovascular coronary treatment at younger age. Although the number of venous thrombolyses as a specific treatment of acute ischemic stroke in Bulgaria is growing, its frequency remains significantly lower than the recommended minimum and represents less than 0.4% of the new stroke cases per year. The endovascular procedures in hemorrhagic stroke are also very low – approximately 0.5–1.4% per year. Efforts are needed for adequate financing of the health care facilities, professional training of human resources and education of the population by creating unified national strategy as a state health policy.