Browsing by Author "Jurjāns, Kristaps"

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    Five Year Follow-Up of Cryptogenic Stroke Patients Following Patent Foramen Ovale Closure
    (2021-06-21) Teivāne, Agnete; Jurjāns, Kristaps; Rudzītis, Ainārs; Lazdovska, Krista; Balodis, Artūrs; Miglāne, Evija; Rīga Stradiņš University; Red Cross Medical College of Rīga Stradiņš University; Department of Neurology and Neurosurgery
    According to guidelines, patent foramen ovale (PFO) closure is recommended for secondary stroke prevention in patients with cryptogenic stroke. Paradoxial embolism from PFO-mediated right to left shunt has been described as the mechanism of stroke in these cases. The aim of the study was to determine whether PFO closure can be associated with improvement of complaints (headaches, fatigue, heart palpitations, dizziness, and visual impairment) and determine its long-term effectiveness on recurrent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 year, and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: Male patients accounted for 43.7% (n = 45). The mean age was—44.4 ± 13 (18–75). The most probable cause for cryptogenic stroke for 53.4% (n = 55) of patients with possible cardio-aortic embolism was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder—87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patients presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints
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    Functional Outcome and Mortality of Cardioembolic Stroke Patients Dependent on Antithrombotic Therapy. Doctoral Thesis
    (Rīga Stradiņš University, 2025) Jurjāns, Kristaps; Miglāne, Evija; Priede, Zanda
    Stroke, classified by the World Health Organisation (WHO) as a cardiovascular disease, remains a leading cause of mortality and morbidity, while ischaemic stroke (IS) is the second most common cause of death and a significant contributor to disability-adjusted life years (DALYs) lost worldwide. Latvia has an exceptionally high IS incidence and mortality rate compared to other European countries, mainly due to cardioembolic stroke (CS), a severe IS subtype often linked to non-valvular atrial fibrillation (NVAF). Despite advances in treatment, the prevalence of CS is expected to rise, posing a considerable burden on the ageing population. Effective management of NVAF with oral anticoagulants (OACs), particularly target-specific oral anticoagulants (TSOACs), could potentially reduce CS incidence and improve long-term outcomes, yet their use remains suboptimal. This Thesis aims to evaluate the impact of antithrombotic therapy on mortality and long-term functional outcomes in CS patients within the Latvian population. The Thesis is structured in three parts to address various aspects of CS prevention and patient care. The first aspect focuses on primary CS prevention strategies. The second aspect delves into the characteristics and demographics of CS patients during hospitalisation. And the third aspect examines secondary prevention strategies and long-term functional outcomes for these patients. Findings indicate that CS is the most prevalent and severe IS subtype in Latvia. CS patients are typically older, predominantly female, and have higher rates of comorbid conditions. Despite higher reperfusion therapy rates, CS leads to longer hospitalizations, poorer outcomes, and higher in-hospital and long-term mortality. There is significant underuse of antithrombotic medications in NVAF patients, often due to age and stroke severity biases. OACs improve functional outcomes and survival in CS patients, with TSOACs preferred over vitamin K antagonists (VKAs) due to a better safety profile. Proper use of TSOACs is linked to lower long-term mortality and improved functional independence, underscoring their importance in secondary stroke prevention.
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    Functional Outcome and Mortality of Cardioembolic Stroke Patients Dependent on Antithrombotic Therapy. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2025) Jurjāns, Kristaps; Miglāne, Evija; Priede, Zanda
    Stroke, classified by the World Health Organisation (WHO) as a cardiovascular disease, remains a leading cause of mortality and morbidity, while ischaemic stroke (IS) is the second most common cause of death and a significant contributor to disability-adjusted life years (DALYs) lost worldwide. Latvia has an exceptionally high IS incidence and mortality rate compared to other European countries, mainly due to cardioembolic stroke (CS), a severe IS subtype often linked to non-valvular atrial fibrillation (NVAF). Despite advances in treatment, the prevalence of CS is expected to rise, posing a considerable burden on the ageing population. Effective management of NVAF with oral anticoagulants (OACs), particularly target-specific oral anticoagulants (TSOACs), could potentially reduce CS incidence and improve long-term outcomes, yet their use remains suboptimal. This Thesis aims to evaluate the impact of antithrombotic therapy on mortality and long-term functional outcomes in CS patients within the Latvian population. The Thesis is structured in three parts to address various aspects of CS prevention and patient care. The first aspect focuses on primary CS prevention strategies. The second aspect delves into the characteristics and demographics of CS patients during hospitalisation. And the third aspect examines secondary prevention strategies and long-term functional outcomes for these patients. Findings indicate that CS is the most prevalent and severe IS subtype in Latvia. CS patients are typically older, predominantly female, and have higher rates of comorbid conditions. Despite higher reperfusion therapy rates, CS leads to longer hospitalizations, poorer outcomes, and higher in-hospital and long-term mortality. There is significant underuse of antithrombotic medications in NVAF patients, often due to age and stroke severity biases. OACs improve functional outcomes and survival in CS patients, with TSOACs preferred over vitamin K antagonists (VKAs) due to a better safety profile. Proper use of TSOACs is linked to lower long-term mortality and improved functional independence, underscoring their importance in secondary stroke prevention.
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    Histopathological Profile of Thrombi Differs Depending on Pathogenesis of Embolic Cerebral Infarction and Evidence of Intracardiac Thrombus
    (2023) Meļņikova, Vlada; Jurjāns, Kristaps; Kupča, Katrīna; Vētra, Jānis; Lapse, Daira; Veiss, Andris; Nazarovs, Jurijs; Miglāne, Evija; Department of Doctoral Studies; Department of Neurology and Neurosurgery
    Background and Objectives: Determining the etiopathogenesis of stroke is a cornerstone for correct secondary prophylaxis, however, in up to 40% the precise source of embolism cannot be determined. The aim of our study was to investigate histopathological differences of emboli retrieved during mechanical thrombectomy, and to investigate how radiological findings and ischemic stroke outcomes correlate with histopathological profile of thrombi. Materials and Methods: In total 40 stroke patients were included in the study. Histopathological examination was performed using Hematoxylin and Eosin staining. Subsequently, on the basis of hematoxylin-andeosin staining, the percentage and area of erythrocytes, leukocytes, and fibrin in investigated thrombi were measured. Thrombi were stained immunohistochemically, according to manufacturer`s instructions. The results were compared in supposed etiopathological stroke subtype groups as cardioembolic, atheroembolic and cryptogenic. Correlation between histopathology of thrombi and stroke outcomes, as well as radiological findings, that is hyperdense artery sign and presence of thrombi in left atrium appendage on nonenhanced thoracic Computed Tomography, was also performed. Results: There were 26 cardioembolic thrombi, 7 atheroembolic and 7 cryptogenic thrombi. Atheroembolic thrombi had a higher percentage of the fibrin area versus total thrombi area than cryptogenic thrombi (p=0.038) and similar tendency comparing with cardioembolic thrombi (p=0.099). Cryptogenic thrombi had statistically lower fibrin/leukocytes ratio than atheroembolic thrombi (p=0,026). As to radiological findings, hyperdense artery sign did not correlate with any specific histopathological composition of thrombi, but patients with CT visualized thrombus in the heart had larger erythrocyte area in thrombus than those without mentioned finding (p=0.047). The ischemic stroke outcome in patients after performed mechanical thrombectomy did not correlate with thrombus histopathology. Conclusion: We found partial histologic similarities of cryptogenic thrombi with cardioembolic thrombi. Therefore patients with cryptogenic stroke should probably undergo extensive cardiac examination including long-term heart rhythm monitoring.
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    Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients
    (2022-10) Jurjāns, Kristaps; Cērpa, Marija; Baborikina, Alise; Kalējs, Oskars; Miglāne, Evija; Department of Neurology and Neurosurgery; Department of Doctoral Studies; Department of Internal Diseases
    Background and Objectives: Stroke is currently the second most common cause of death and disability-adjusted life years worldwide. Previous studies have determined that cardioembolic stroke is associated with higher mortality. Our aim is to compare the long-term outcome and mortality of atherothrombotic, cardioembolic stroke patients and patients taking direct oral anticoagulants (DOACs), and to demonstrate that adequate treatment with DOACs is associated with better results. Materials and Methods: In our retrospective study, we collected the data of ischemic stroke patients who were treated at P. Stradins Clinical University Hospital, Riga, Latvia, Stroke Unit, in the year 2017. In the present study, we analyzed this information to assess the patients’ demographic and clinical data, vascular risk factors, functional and neurological evaluation results, and the use of anticoagulant therapy. Stroke survivors were followed-up via telephone at 30/90/180/365 days and 4 years after being discharged from the hospital. The Latvian version of the National Institutes of Health Stroke Scale (NIHSS-LV) was used to evaluate patients’ neurological outcomes at discharge, and patients’ functional outcomes were evaluated using the modified Rankin scale (mRS). The collected data of the patients were separated into three groups according to the stroke subtype and use of direct oral anticoagulants. Results: A total of 654 ischemic stroke patients were admitted to the hospital in the year 2017. Of all the strokes included in the study, 262 presented an atherothrombotic etiology and 392 presented a cardioembolic etiology. The median age of the patients in the study was 76 years (IQR: 67–83). The median age of patients in the atherothrombotic stroke group was 71 years (IQR = 64–79), in the cardioembolic stroke group it was 79 (IQR = 72–84), and in the DOAC group it was 75 years (IQR = 69–82), respectively. At the period of four years, of all the atherothrombotic stroke survivors 14 (10.5%) had a severe disability, and 64 (48.1%) did not survive. However, 12 (4.1%) of the cardioembolic stroke survivors were severely disabled and 37 (12.5%) had died. In the group of patients taking DOACs 6 (4.5%) had a severe disability and 17 (12.9%) did not survive. In all the patient groups, the leading cause of death was due to severe disability (22%), followed by recurrent cardioembolic events (8%). Conclusions: Previous studies until now have concluded that cardioembolic stroke is associated with higher mortality and an unfavorable functional outcome. In our study, the cardioembolic stroke group and the DOAC group had a statistically significant higher percentage of patients with congestive heart failure and older age, but their long-term mortality was lower and they achieved independence more often than the atherothrombotic stroke patients. The proper use of anticoagulants shows great improvement in long-term survival rate and functional outcome.
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    Is Anticoagulation Necessary for Severely Disabled Cardioembolic Stroke Survivors?
    (2019) Jurjāns, Kristaps; Vikmane, Baiba; Vētra (Jr), Jānis; Miglāne, Evija; Kalējs, Oskars; Priede, Zanda; Millers, Andrejs; Department of Neurology and Neurosurgery; Department of Doctoral Studies; Rīga Stradiņš University; Department of Internal Diseases
    Background and Objectives: Oral anticoagulants are the hallmark of cardioembolic stroke prevention, but they are frequently underused, especially in elderly patients and patients with paroxysmal atrial fibrillation. In our paper, we analyzed the long-term outcome of severely disabled cardioembolic stroke survivors depending on the prescribed antithrombotic secondary prevention medication. Materials and Methods: In our study, we retrospectively collected data for ischemic stroke (IS) patients treated in P. Stradins Clinical University hospital, Riga, Latvia, from 2014 until 2017. Patients’ clinical data were collected using local stroke registry, including patients’ demographic data, vascular risk factors, clinical findings, and laboratory results. Severely disabled stroke survivors were followed up by phone at 30/90/180/365 days after discharge. Patients’ functional outcomes were assessed using the adapted version of The Rankin Focused Assessment–Ambulation. The collected data were compared in 4 groups according to prescribed secondary prevention medication. Results: A total of 682 (91.42%) patients were followed up and included in data analysis. The median age of patients was 80 (IQR = 75–85) years. Of these patients, 231 (31%) were males and 515 (69%) were females. One-year probability of survival of patients not taking any preventive medication was 53% (IQR = 29–76), while in patients taking antiplatelet agents it was 57% (IQR = 37–78), 78% (IQR = 68–88) of patients on Vitamin K antagonists (VKA) and 81% (IQR = 72–90) in patients on direct oral anticoagulants (DOACs). One year after discharge 73 (31%) had mRS 0–2, 50 (20.9%), 29 (12.1%) were still severely disabled, and 87 (36.4%) had died. Conclusions: Anticoagulant use in secondary prevention predicts better functional outcome and higher survival rate in patients with severe cardioembolic stroke due to non-valvular atrial fibrillation (NVAF), therefore severe neurological deficit must not be a reason of restriction of anticoagulatio
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    Kardioemboliska insulta funkcionālais iznākums un mirstība atkarībā no antitrombotiskās terapijas, klīniskiem un demogrāfiskiem datiem. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2025) Jurjāns, Kristaps; Miglāne, Evija; Priede, Zanda
    Pasaules Veselības organizācija insultu pieskaita kardiovaskulārajām slimībām, kas ir galvenais nāves iemesls visā pasaulē, išēmisks insults (AII) ir otrais izplatītākais nāves cēlonis un trešais biežākais invaliditātes koriģēto dzīves gadu (DALYs – disability-adjusted life years) iemesls. Salīdzinot ar citām Eiropas valstīm, Latvijā saslimstība ar AII ir ļoti augsta, tam iemesls varētu būt lielāks kardioemboliska insulta (KEI) īpatsvars. Tradicionāli tiek uzskatīts, ka KEI ir smagākais no AII subtipiem, un tas bieži tiek saistīts ar nevalvulāru ātriju fibrilāciju (NVĀF). Pēdējo gadu laikā būtiski uzlabojušās insulta profilakses un akūtās ārstēšanas iespējas šim insulta subtipam, tomēr, populācijai novecojot, tiek prognozēts, ka KEI sastopamība būtiski pieaugs, radot papildu slogu veselības aprūpes sistēmai un sabiedrībai. Atbilstoši pieejamām vadlīnijām visiem pacientiem ar NVĀF insulta profilaksē nepieciešams saņemt perorālos antikoagulantus (OAC), bet nav skaidru rekomendāciju sekundārās profilakses izvēlē pacientiem ar izteiktu neiroloģisko deficītu pēc pārciesta insulta. Līdz ar to liela daļa šo pacientu nesaņem adekvātu sekundāro profilaksi. Līdzīgi pētījumi par ilgtermiņa mirstību un funkcionālo iznākumu pašreiz literatūrā nav publicēti, jo lielākajā daļā pētījumu pacientus nenovēro ilgāk par 90 dienām, tādēļ nav skaidri zināms, kas notiek ar šiem pacientiem vēlākā periodā. Promocijas darba mērķis ir novērtēt antitrombotiskas terapijas ietekmi uz mirstību un ilgtermiņa funkcionālo iznākumu KEI pacientiem Latvijā. Promocijas darbs ir strukturēts trijās daļās, lai izvērtētu dažādus KEI profilakses un pacientu aprūpes aspektus. Pirmajā daļā tiek izvērtēti dažādi primārās profilakses aspekti gan no pacienta, gan ārsta skatpunkta. Otrajā daļā tiek izvērtēti un salīdzināti KEI pacientu klīniskie un demogrāfiskie dati, savukārt trešajā daļā aplūkota KEI sekundārā profilakse un ilgtermiņa funkcionālais iznākums. Rezultāti liecina, ka KEI patiesi ir visizplatītākais un klīniski smagākais AII apakštips Latvijā. KEI pacienti galvenokārt ir vecāki, tie biežāk ir sieviešu dzimuma un bieži ir multimorbīdi. Lai gan KEI pacienti biežāk saņem reperfūzijas terapiju, šiem pacientiem raksturīgs ilgāks stacionēšanās laiks, nelabvēlīgāks funkcionālais iznākums un augstāka intrahospitālā, kā arī ilgtermiņa mirstība. KEI profilakse pacientiem ar NVĀF ir nepietiekama, lielai daļai pacientu nesaņemot atbilstošus medikamentus vecuma un/vai agrīni nelabvēlīga insulta funkcionālā iznākuma dēļ. OAC lietošana uzlabo ilgtermiņa funkcionālo iznākumu un samazina mirstību KEI pacientiem. Tiešas darbības antikoagulantiem (TSOAC) ir būtiskas priekšrocības pār K vitamīna antagonistiem galvenokārt to drošības profilu dēļ. Efektīva TSOAC lietošana KEI profilaksē pacientiem ar NVĀF ir saistīta ar labāku ilgtermiņa funkcionālo iznākumu un zemāku mirstību.
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    Prehospital Stroke Care. Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania
    (2022-10) Melaika, Kazimieras; SVEIKATA, Lukas; Vilionskis, Aleksandras; Wiśniewski, Adam; Jurjāns, Kristaps; Klimašauskas, Andrius; Jatužis, Dalius; Masiliūnas, Rytis; Department of Neurology and Neurosurgery
    Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs. 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs. 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumors (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.
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    A Rare Case of Cervical Spinal Arteriovenous Malformation : A Case Report
    (2024-06) Ošiņa, Jolanta; Jurjāns, Kristaps; Kupčs, Kārlis; Rzajeva, Tatjana; Miglāne, Evija; Department of Neurology and Neurosurgery
    Arteriovenous malformation (AVM) is an abnormal connection of vasculature resulting in capillary bed bypassing and leading to neurological deterioration and high risk of bleeding. Intramedullary AVMs in the cervical spinal cord are rare and require precise diagnostics and treatment. We present a clinical case of recurrent AVMs in a 28-year-old Caucasian female with sudden and severe neck pain and variable neurological symptoms along with current diagnostic and treatment modalities. Conservative treatment was partially effective. MRI and DSA confirmed AVMs at C4 level with subsequent several endovascular treatment sessions at the age of 15 and 24 with mild neurological improvement. Afterwards the patient underwent rehabilitation with minor neurological improvement. This case highlights the clinical progression and treatment of AVMs along with showcasing current pathophysiology, classification, and imaging.
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    Successful Mechanical Thrombectomy for Basilar Artery Occlusion in a Pediatric Patient : A Case Report
    (2023-10) Teivāne, Agnete; Naļivaiko, Inga; Jurjāns, Kristaps; Vētra, Jānis; Veiss, Andris; Novaša, Arina; Dzelzīte, Sarmīte; Krieviņš, Dainis; Miglāne, Evija; Department of Neurology and Neurosurgery; Red Cross Medical College of Rīga Stradiņš University
    Studies have shown the benefits of endovascular treatment (EVT) in adult stroke cases, but its application in pediatric stroke remains controversial. Despite evidence of improved outcomes in adults, there are no established recommendations for EVT in children. Conducting individual case reports and case series is vital to understanding its potential advantages and disadvantages in this context. In this case report, a 9-year-old male initially diagnosed with gastroenteritis developed sudden left-sided weakness 1 day after admission. Comprehensive imaging revealed acute ischemia in the cerebellum, indicating a basilar artery thrombus. Urgent endovascular treatment (EVT) was performed 8.5 h after the onset of neurological symptoms, achieving successful revascularization. The patient underwent rehabilitation and was later discharged with improved neurological status. Despite extensive investigations, the stroke’s origin remained unknown. After six months, the patient exhibited complete neurological recovery, highlighting the patient’s remarkable resilience.
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    Tenecteplase or Alteplase Better in Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion : A Single Center Observational Study
    (2022-08-28) Teivane, Agnete; Jurjāns, Kristaps; Vētra, Jānis; Grigorjeva, Jekaterina; Kupcs, Karlis; Masiliūnas, Rytis; Miglāne, Evija; Department of Neurology and Neurosurgery; Red Cross Medical College of Rīga Stradiņš University; Department of Radiology
    Background and Objectives: The study aimed to investigate the efficacy of intravenous thrombolysis with Tenecteplase before thrombectomy for acute ischemic stroke (AIS) patients compared with previous results using Alteplase. Previous trials for Tenecteplase have indicated an increased incidence of vascular reperfusion. In April 2021, we started to primarily give Tenecteplase to patients eligible to undergo thrombectomy. Materials and Methods: In this retrospective observational single-center non-randomized study, we analyzed directly admitted patients with AIS who had occlusion of the internal carotid, middle cerebral, or basilar artery and who underwent thrombectomy, as well as the recanalization rate for these patients at the first angiographic assessment (mTICI score 2b–3), and complications. Results: We included 184 patients (demographic characteristics did not differ between Tenecteplase and Alteplase groups (mean age 68.4 vs. 73.0 years; female sex 53.3% vs. 51.1%, NIHSS 14 (IQR 4–26) vs. 15 (2–31). Forty-five patients received Tenecteplase and 139 Alteplase before endovascular treatment (EVT). Pre-EVT (endovascular treatment) recanalization was more likely to occur with Tenecteplase rather than Alteplase (22.2% vs. 8.6%, p = 0.02). Successful reperfusion (mTICI 2b–3) after EVT was achieved in 155 patients (42 (93.4%) vs. 113 (81.3), p = 0.07). Hemorrhagic imbibition occurred in 15 (33.3%) Tenecteplase-treated patients compared with 39 (28.1%) Alteplase-treated patients (p = 0.5). Patients treated with Tenecteplase had higher odds of excellent functional outcome than Alteplase-treated patients (Tenecteplase 48.6% vs. Alteplase 26.1%; OR 0.37 (95% CI 0.17–0.81), p = 0.01). Conclusions: Tenecteplase (25 mg/kg) could have superior clinical efficacy over Alteplase for AIS patients with large-vessel occlusion (LVO), administered before EVT. The improvement in reperfusion rate and the better excellent functional outcome could come without an increased safety concern.