Browsing by Author "Miglāne, Evija"
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Item Acute Ischemic Stroke Endovascular Treatment of Patients with Large Vessel Occlusions(2015-01-01) Balodis, Arturs; Radzina, Maija; Miglāne, Evija; Valante, Ramona; Millers, Andrejs; Kupčs, Kārlis; Rīga Stradiņš University; Department of Neurology and NeurosurgeryMechanical thrombectomy as an active treatment method has recently been chosen for patients with large artery occlusions and thrombolysis beyond a time window. The aim of our study was to evaluate the results of endovascular treatment in patients with proximal vessel occlusion, compare this group with the intravenous thrombolysis group, and to identify possible criteria of active treatment. The prospective study included 81 patients hospitalised in the Pauls Stradiņš Clinical University Hospital due to acute ischemic stroke; 48 of them received mechanical thrombectomy and 33-intravenous thrombolysis. Thrombectomy (TE) was performed using Solitaire FR stent retrievers. The NIHSS score was used for evaluation of early therapy results and mRS (modified Rankin Scale) was used for late therapy results. ASPECTS was used to define the lesion size using imaging on admission and after treatment. Median NIHSS on admission was higher in the TE group-16 (range 12 to 19) than in the TL group-12 (range 8 to 15) (p < 0.05). Ninety days after treatment, mRS (0-2) was seen in 67% of patients in the TE group (n = 29), and 34% of patients in the TL group (n = 9) patients (p < 0.05). Median ASPECTS was lower in TE group-5, in comparison to the TL group-7 (p < 0.01) Mortality frequency was higher in the TL group (p > 0.05). Frequency of symptomatic intracerebral haemorrhages was similar in the groups. Mechanical thrombectomy can achieve better late functional outcome than thrombolysis in a selected patients group.Item Antiplatelet Resistance in Patients with Atherosclerosis(2019-08) Locāne, Sintija; Pūcīte, Elīna; Miglāne, Evija; Millers, Andrejs; Novasa, Arina; Ieviņa, Renija; Muravska, Tatjana; Department of Neurology and NeurosurgeryVariable platelet response to aspirin and clopidogrel is a well-known phenomenon in patients with coronary artery disease and ischemic cerebral stroke. The objective of the present study was to evaluate the frequency and possible risk factors of antiplatelet resistance in patients with cerebrovascular and cardiovascular diseases. The VerifyNow system was used to evaluate adenosine-5-diphosphate and platelet P2YI2 receptor function in patients with cerebrovascular and cardiovascular disease, who received dual antiplatelet therapy. Aspirin resistance was defined as aspirin reaction units (ARU) >= 550. Clopidogrel resistance was defined as Platelet Reaction Units (PRU) > 230. In the group of cerebrovascular diseases there were 13.2% (n = 27) patients with aspirin and 24.5% (n = 50) with clopidogrel resistance. However, in the cardiovascular group there were 20% (n = 9) aspirin and 11.1% (n = 5) clopidogrel resistant patients. In the cerebrovascular group, aspirin resistant patients had a lower triglyceride level (p = 0.001, r = 0.26) than aspirin sensitive patients. Clopidogrel resistant patients had a significantly higher level of glycated haemoglobin (HbA1C) (p = 0.016, r = 023), triglycerides (p = 0.033, r = 0.16) and lower level of high-density lipoproteins (p = 0.027, r = 0.16) than clopidogrel sensitive patients. In the cardiovascular group, patients who were resistant to aspirin had a significantly higher high-density lipoprotein level (p = 0.038, r = 0.31). No other factors differed significantly between the aspirin or clopidogrel resistant and sensitive patients in the cardiovascular group. Aspirin resistance was more common in patients with cardiovascular disease, and clopidogrel resistance in patients with cerebrovascular disease, although the difference was not significant. Our findings indicate that diabetes mellitus and an elevated level of lipoproteins could be risk factors for aspirin or clopidogrel resistance in patients with cerebrovascular diseases. Further studies should be conducted using larger patient cohorts with balanced groups of patients to investigate clinical aspects of antiplatelet resistance.Item Ar veselību saistītas dzīves kvalitātes izmaiņas pēc nozīmīgas miega artērijas stenozes ārstēšanas. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2020) Pūcīte, Elīna; Miglāne, Evija; Krieviņš, DainisMiega artērijas stenoze ir nozīmīgs išēmiska insulta riska faktors. Aptuveni 10–15% gadījumu išēmisks insults rodas trombembolijas dēļ no iepriekš asimptomātiskas iekšējās miega artērijas > 50% stenozes. Pacientiem pēc pārciesta išēmiska insulta ir ne tikai fiziski funkcionāli ierobežojumi, bet bieži attīstās arī kognitīvi traucējumi un vaskulāra depresija. Tieši pēdējo desmit gadu laikā ir pieaugusi interese par nozīmīgas miega artērijas stenozes izraisītiem “neklasiskajiem” neiroloģiskajiem simptomiem un to saistību ar dzīves kvalitāti, kā arī revaskularizācijas ietekmi uz šo simptomu attīstību. Promocijas darbs “Ar veselību saistītas dzīves kvalitātes izmaiņas pēc nozīmīgas miega artērijas stenozes ārstēšanas” veltīts kopējās kognitīvās funkcijas, depresijas simptomu un dzīves kvalitātes izpētei, jo mūsdienīgas nozīmīgas miega artērijas stenozes ārstēšanas mērķis ir ne tikai samazināt išēmiska insulta risku un pagarināt dzīvildzi, bet arī nodrošināt pietiekoši labu ar veselību saistītu dzīves kvalitāti ilgtermiņā kopumā. Promocijas darba mērķis bija izpētīt kognitīvās funkcijas un ar veselību saistītas dzīves kvalitātes izmaiņas, depresijas simptomu dinamiku, kā arī precizēt cerebrovaskulāro notikumu un mirstības biežumu pacientiem, kuriem veikta nozīmīgas miega artērijas stenozes revaskularizācija vai pielietota tikai medikamentozā terapija. Pētniecības darbā tika iekļauti un analizēti 213 pacienti ar nozīmīgu miega artērijas stenozi, kuriem vai nu veica revaskularizāciju ķirurģiski vai endovaskulāri, vai arī tikai uzsāka optimālu medikamentozo terapiju bez miega artērijas revaskularizācijas. Visiem pacientiem atkārtoti novērtēja kognitīvās funkcijas, depresijas simptomu un ar veselību saistītas dzīves kvalitātes izmaiņas gada laikā. Pētījuma rezultāti liecina, ka nozīmīgas miega artērijas stenozes revaskularizācija varētu būt saistīta ar globālās kognitīvās funkcijas uzlabošanos. Savukārt depresijas simptomu izmaiņas pēc nozīmīgas miega artērijas stenozes revaskularizācijas un/vai medikamentozās ārstēšanas netika novērotas. Kopumā pacientiem gadu pēc miega artērijas endarterektomijas dzīves kvalitātes saglabājā tādā pašā līmenī kā pirms operācijas. Taču dzīves kvalitātes izmaiņu novērtēšanu pēc miega artērijas stentēšanas un medikamentozās ārstēšanas ietekmēja dažādi klīniskie parametri šajās grupās, tāpēc pārliecinošus secinājumus šobrīd veikt nav iespējams.Item Ar veselību saistītas dzīves kvalitātes izmaiņas pēc nozīmīgas miega artērijas stenozes ārstēšanas. Promocijas darbs(Rīgas Stradiņa universitāte, 2020) Pūcīte, Elīna; Miglāne, Evija; Krieviņš, DainisMiega artērijas stenoze ir nozīmīgs išēmiska insulta riska faktors. Aptuveni 10–15% gadījumu išēmisks insults rodas trombembolijas dēļ no iepriekš asimptomātiskas iekšējās miega artērijas > 50% stenozes. Pacientiem pēc pārciesta išēmiska insulta ir ne tikai fiziski funkcionāli ierobežojumi, bet bieži attīstās arī kognitīvi traucējumi un vaskulāra depresija. Tieši pēdējo desmit gadu laikā ir pieaugusi interese par nozīmīgas miega artērijas stenozes izraisītiem “neklasiskajiem” neiroloģiskajiem simptomiem un to saistību ar dzīves kvalitāti, kā arī revaskularizācijas ietekmi uz šo simptomu attīstību. Promocijas darbs “Ar veselību saistītas dzīves kvalitātes izmaiņas pēc nozīmīgas miega artērijas stenozes ārstēšanas” veltīts kopējās kognitīvās funkcijas, depresijas simptomu un dzīves kvalitātes izpētei, jo mūsdienīgas nozīmīgas miega artērijas stenozes ārstēšanas mērķis ir ne tikai samazināt išēmiska insulta risku un pagarināt dzīvildzi, bet arī nodrošināt pietiekoši labu ar veselību saistītu dzīves kvalitāti ilgtermiņā kopumā. Promocijas darba mērķis bija izpētīt kognitīvās funkcijas un ar veselību saistītas dzīves kvalitātes izmaiņas, depresijas simptomu dinamiku, kā arī precizēt cerebrovaskulāro notikumu un mirstības biežumu pacientiem, kuriem veikta nozīmīgas miega artērijas stenozes revaskularizācija vai pielietota tikai medikamentozā terapija. Pētniecības darbā tika iekļauti un analizēti 213 pacienti ar nozīmīgu miega artērijas stenozi, kuriem vai nu veica revaskularizāciju ķirurģiski vai endovaskulāri, vai arī tikai uzsāka optimālu medikamentozo terapiju bez miega artērijas revaskularizācijas. Visiem pacientiem atkārtoti novērtēja kognitīvās funkcijas, depresijas simptomu un ar veselību saistītas dzīves kvalitātes izmaiņas gada laikā. Pētījuma rezultāti liecina, ka nozīmīgas miega artērijas stenozes revaskularizācija varētu būt saistīta ar globālās kognitīvās funkcijas uzlabošanos. Savukārt depresijas simptomu izmaiņas pēc nozīmīgas miega artērijas stenozes revaskularizācijas un/vai medikamentozās ārstēšanas netika novērotas. Kopumā pacientiem gadu pēc miega artērijas endarterektomijas dzīves kvalitātes saglabājā tādā pašā līmenī kā pirms operācijas. Taču dzīves kvalitātes izmaiņu novērtēšanu pēc miega artērijas stentēšanas un medikamentozās ārstēšanas ietekmēja dažādi klīniskie parametri šajās grupās, tāpēc pārliecinošus secinājumus šobrīd veikt nav iespējams.Item Cerebrāla infarkta agrīnas attēldiagnostikas un reperfūzijas taktikas saistība ar radioloģisko un klīnisko iznākumu. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2020) Balodis, Arturs; Kupčs, Kārlis; Miglāne, EvijaPromocijas darbā ”Cerebrāla infarkta agrīnas attēldiagnostikas un reperfūzijas taktikas saistība ar radioloģisko un klīnisko iznākumu” ir aplūkota viena no aktuālākajām mūsdienu problēmām – cerebrāla infarkta diagnostika un aktīva ārstēšana. Cerebrāls infarkts ir viens no galvenajiem mirstības un ilgstošas invaliditātes cēloņiem pasaulē ar lielu sociālu ietekmi. Darba mērķis bija izvērtēt akūta išēmiska insulta multimodālas datortomogrāfijas (CT) diagnostikas un aktīvas ārstēšanas taktikas saistību ar radioloģisko un klīnisko iznākumu. Pētījumā tika iekļauti 288 pacienti ar akūtu išēmisku insultu pacientiem ar lielo cerebrālo asinsvadu oklūziju. Promocijas darbā analizētas līdz šim nepietiekami izpētītas problēmas akūta cerebrāla infarkta aktīvā ārstēšanā pacientiem ar lielo cerebrālo artēriju slēgumu: izolētas endovaskulāras trombektomijas pielietojums, salīdzinot ar kombinētu terapiju (intravenoza trombolīze ar sekojošu endovaskulāru trombektomiju) un trombolīzi vienu pašu, kā arī analizēta rekanalizācijas efektivitāte mugurējā cirkulācijas teritorijā. Darbā novērtētas ārstēšanas komplikācijas, kā arī trombektomijas procedūras parametri, piemēram, mēģinājumu skaits līdz rekanalizācijai un procedūras ilgums. Endovaskulāras ārstēšanas rezultātā var sasniegt augstu rekanalizācijas pakāpi, kas ne vienmēr korelē ar labu klīnisko iznākumu, tāpēc vitāli svarīga ir pacientu atlase, ko iespējams uzlabot, izmantojot mūsdienīgu radioloģisku izmeklēšanu, radioloģisko attēlu izvērtēšanu un pēcapstrādi. Darbā veikts tādu radioloģisku kritēriju novērtējums ārstēšanas taktikas izvēlē un potenciālā iznākuma prognozēšanā kā kolaterāles, insulta apjoms pēc ASPECTS skalas, oklūzijas vieta u. c. Pētījumā tika konstatēti statistiski nozīmīgi labāki rezultāti pacientiem, kuriem veikta endovaskulāra ārstēšana, salīdzinot ar pacientiem, kuriem pielietoja izolētu intravenozu trombolīzi pie lielo cerebrālo artēriju oklūzijas. Rezultāti parādīja, ka kombinētās terapijas (intravenoza trombolīze ar sekojošu endovaskulāru trombektomiju) klīniskais iznākums ir līdzīgs kā izolētas endovaskulāras trombektomijas gadījumā, turklāt bez nozīmīga komplikāciju skaita pieauguma. Endovaskulāras trombektomijas rezultātā pacientiem ar lielo cerebrālo artēriju oklūziju vairumā gadījumu tika sasniegta augsta rekanalizācijas pakāpe, turklāt komplikāciju risks izrādījās zems. Agrīna multimodāla CT izmeklēšana ir vitāli svarīga pacientu atlasē aktīvai ārstēšanai, lai sasniegtu labu vēlīno klīnisko iznākumu. Radioloģiskie parametri – labas kolaterāles un sākotnēji definētā infarkta apjoma lielums CT perfūzijā ASPECTS skalā ≥ 6 statistiski nozīmīgi korelēja ar labāku klīnisko un funkcionālo iznākumu, kas atkarīgs no daudziem faktoriem, jo īpaši no veiksmīgas rekanalizācijas un reperfūziju. Pētījuma ietvaros izstrādātas rekomendācijas un rīcības algoritms akūta cerebrāla infarkta aktīvai terapijai un pacientu atlasei ar pierādītu lielo cerebrālo artēriju oklūziju.Item Cerebrāla infarkta agrīnas attēldiagnostikas un reperfūzijas taktikas saistība ar radioloģisko un klīnisko iznākumu. Promocijas darbs(Rīgas Stradiņa universitāte, 2020) Balodis, Arturs; Kupčs, Kārlis; Miglāne, EvijaPromocijas darbā ”Cerebrāla infarkta agrīnas attēldiagnostikas un reperfūzijas taktikas saistība ar radioloģisko un klīnisko iznākumu” ir aplūkota viena no aktuālākajām mūsdienu problēmām – cerebrāla infarkta diagnostika un aktīva ārstēšana. Cerebrāls infarkts ir viens no galvenajiem mirstības un ilgstošas invaliditātes cēloņiem pasaulē ar lielu sociālu ietekmi. Darba mērķis bija izvērtēt akūta išēmiska insulta multimodālas datortomogrāfijas (CT) diagnostikas un aktīvas ārstēšanas taktikas saistību ar radioloģisko un klīnisko iznākumu. Pētījumā tika iekļauti 288 pacienti ar akūtu išēmisku insultu pacientiem ar lielo cerebrālo asinsvadu oklūziju. Promocijas darbā analizētas līdz šim nepietiekami izpētītas problēmas akūta cerebrāla infarkta aktīvā ārstēšanā pacientiem ar lielo cerebrālo artēriju slēgumu: izolētas endovaskulāras trombektomijas pielietojums, salīdzinot ar kombinētu terapiju (intravenoza trombolīze ar sekojošu endovaskulāru trombektomiju) un trombolīzi vienu pašu, kā arī analizēta rekanalizācijas efektivitāte mugurējā cirkulācijas teritorijā. Darbā novērtētas ārstēšanas komplikācijas, kā arī trombektomijas procedūras parametri, piemēram, mēģinājumu skaits līdz rekanalizācijai un procedūras ilgums. Endovaskulāras ārstēšanas rezultātā var sasniegt augstu rekanalizācijas pakāpi, kas ne vienmēr korelē ar labu klīnisko iznākumu, tāpēc vitāli svarīga ir pacientu atlase, ko iespējams uzlabot, izmantojot mūsdienīgu radioloģisku izmeklēšanu, radioloģisko attēlu izvērtēšanu un pēcapstrādi. Darbā veikts tādu radioloģisku kritēriju novērtējums ārstēšanas taktikas izvēlē un potenciālā iznākuma prognozēšanā kā kolaterāles, insulta apjoms pēc ASPECTS skalas, oklūzijas vieta u. c. Pētījumā tika konstatēti statistiski nozīmīgi labāki rezultāti pacientiem, kuriem veikta endovaskulāra ārstēšana, salīdzinot ar pacientiem, kuriem pielietoja izolētu intravenozu trombolīzi pie lielo cerebrālo artēriju oklūzijas. Rezultāti parādīja, ka kombinētās terapijas (intravenoza trombolīze ar sekojošu endovaskulāru trombektomiju) klīniskais iznākums ir līdzīgs kā izolētas endovaskulāras trombektomijas gadījumā, turklāt bez nozīmīga komplikāciju skaita pieauguma. Endovaskulāras trombektomijas rezultātā pacientiem ar lielo cerebrālo artēriju oklūziju vairumā gadījumu tika sasniegta augsta rekanalizācijas pakāpe, turklāt komplikāciju risks izrādījās zems. Agrīna multimodāla CT izmeklēšana ir vitāli svarīga pacientu atlasē aktīvai ārstēšanai, lai sasniegtu labu vēlīno klīnisko iznākumu. Radioloģiskie parametri – labas kolaterāles un sākotnēji definētā infarkta apjoma lielums CT perfūzijā ASPECTS skalā ≥ 6 statistiski nozīmīgi korelēja ar labāku klīnisko un funkcionālo iznākumu, kas atkarīgs no daudziem faktoriem, jo īpaši no veiksmīgas rekanalizācijas un reperfūziju. Pētījuma ietvaros izstrādātas rekomendācijas un rīcības algoritms akūta cerebrāla infarkta aktīvai terapijai un pacientu atlasei ar pierādītu lielo cerebrālo artēriju oklūziju.Item Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment(2019) Pūcīte, Elīna; Krievina, Ildze; Miglāne, Evija; Erts, Renārs; Krievins, Dainis; Millers, Andrejs; Department of Neurology and NeurosurgeryBackground: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT). Methods: Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months followup periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only. Results: Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period. Conclusion: Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.Item Changes in Health-related Quality of Life After Carotid Stenosis Treatment. Summary of the Doctoral Thesis(Rīga Stradiņš University, 2020) Pūcīte, Elīna; Miglāne, Evija; Krieviņš, DainisCarotid artery stenosis is well-known causal risk factor for ischaemic stroke. Approximately 10–15% of all strokes follow thromboembolism from previously asymptomatic > 50% internal carotid stenosis. In addition to functional disability, stroke patients frequently go on to develop cognitive impairment and depression. In the last decade there is growing interest of “nonclassical” neurological symptoms caused by severe carotid stenosis and it’s associaton with the health-related quality of life and whether carotid interventions improve the development of these symptoms. The doctoral thesis “Changes in Health-Related Quality of Life after Carotid Stenosis Treatment” is devoted to investigation of global cognitive function, depressive symptoms and health-related quality of life because the goal of contemporary carotid stenosis management is not only to reduce stroke risk and to extend life expectancy but also to ensure a sufficient high long-term health-related quality of life. The aim of this study was to assess long-term changes in cognitive function, depressive symptoms and health-related quality of life after carotid stenosis revascularisation and the best medical treatment. Study involved 213 patients with severe carotid stenosis who underwent assessment of cognitive function, depressive symptoms and health-related quality of life. The assessment was performed before and at 6 and 12 months follow-up periods in patients who had carotid endarterectomy, carotid artery stenting or received the best medical treatment only. The research results show that revascularisation of severe carotid stenosis may be associated with improvement of global cognitive function. Whereas there was no significant change of depressive symptoms neither after revascularisation, nor after the best medical treatment. In general, carotid endarterectomy maintain preoperative health-related quality of life for at least one year. However, the evaluation of change in health-related quality of life in the carotid stenting and the best medical treatment group was influenced by several clinical parameters. Therefore, conclusive statements were not made at the moment.Item Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis(2019) Balodis, Arturs; Radziņa, Maija; Miglāne, Evija; Rudd, Anthony; Millers, Andrejs; Savlovskis, Janis; Kupčs, Kārlis; Department of RadiologyBackground Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven. Purpose To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment. Material and Methods In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT. All patients were selected for treatment based on clinical criteria, multimodal computed tomography (CT) imaging. Eighty-four patients were treated with bridging IVT followed by EVT; 62 patients were treated with EVT only. Results Bridging therapy did not influence endovascular procedure time (P = 0.71) or number of attempts needed (P = 0.63). Bleeding from any site was more common in the bridging group (27, 32%) vs. the EVT group (12, 19%) (P = 0.09). Functional independence modified Rankin Scale after 90 days was slightly higher in the bridging group (44%) vs. the EVT group (42%) (P = 0.14). Mortality did not differ significantly at 90 days: 17% in the bridging group vs. 21% in EVT alone (P = 0.57). Both treatment methods showed high recanalization rates: 94% in the bridging group and 89% for EVT alone. Conclusion Bridging treatment in LVO did not show benefits or elevated risks of complications in comparison to EVT only. The bridging group did not show significantly better neurological outcome or significant impact on procedural parameters vs. EVT aloneItem 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 NeurosurgeryAccording 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 complaintsItem Functional Outcome and Mortality of Cardioembolic Stroke Patients Dependent on Antithrombotic Therapy. Doctoral Thesis(Rīga Stradiņš University, 2025) Jurjāns, Kristaps; Miglāne, Evija; Priede, ZandaStroke, 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.Item 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, ZandaStroke, 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.Item Health-Related Quality of Life among Patients with Severe Carotid Artery Stenosis(2015-01-01) Pucite, Elina; Šlisers, Marius; Miglāne, Evija; Krieviņš, Dainis; Millers, Andrejs; Blimhena, Inese; Department of Neurology and NeurosurgeryInformation about changes of health-related quality of life (HRQoL) after revascularisation as well how revascularisation procedure influences daily activities, cognitive functioning and general health is controversial. The objectives of our study were to evaluate and describe the HRQoL among patients with severe carotid artery disease; to evaluate the difference of HRQoL between symptomatic and asymptomatic carotid artery disease; and to explore the possible associations between some demographic and clinical characteristics of patients with carotid artery disease and HRQoL. The cross-sectional study included 33 patients who were referred for carotid artery endarterectomy. Data assessment was done one to three days before surgery. The HRQoL was assessed using the Medical Outcome Survey Form 36 (SF-36v2). Patients with symptomatic carotid artery disease had the lowest mean SF-36v2 scores for physical functioning, role-physical, general health and mental health. There was moderate correlation (rs= 0.441) between mean SF-36v2 scores of mental health and Montreal Cognitive Assessment Scale (MoCA) scores. There is also indirect indication for probable correlation between MoCA test scores and mean SF-36v2 scores of social functioning, which might become statistically significant if more patients would be included. Patients with severe carotid artery disease in our study had lower mean SF-36v2 scores for role-physical, for bodily pain and for perception about their health status (general health). HRQoL in patients with severe carotid artery, stenosis was poorer in patients with symptomatic carotid artery disease and was not affected by gender and other clinical characteristics.Item 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 NeurosurgeryBackground 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.Item History of Academic Neurology in Latvia(2015-09-01) Balta, Anita; Miglāne, Evija; Logina, Inra; Viksna, Arnis; Millers, Andrejs; Department of Neurology and NeurosurgeryItem 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 DiseasesBackground 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.Item 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 DiseasesBackground 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 anticoagulatioItem Ischemic Stroke Due to Middle Cerebral Artery M1 Segment Occlusion : Latvian Stroke Register Data(2015-09-01) Valante, Ramona; Blimhena, Inese; Miglāne, Evija; Millers, Andrejs; Balodis, Arturs; Pucite, Elina; Department of Neurology and NeurosurgeryThe occlusion of middle cerebral artery (MCA) is the most common cause of ischemic stroke. A retrospective single centre analysis of ischemic stroke was conducted using data from the Latvian Stroke Register in the period from January 2013 till December 2014. The study included 478 patients who had confirmed MCA occlusion using computed tomography angiography (CTA). Half of the patients were males-237 (49.6%), average age 69.51, average age of females was 74.58 years. Cardioembolic stroke was the most common cause of MCA M1 segment occlusion in 294 (61.5%) cases. Small cerebral artery occlusion was not a cause of M1 MCA occlusion. The reperfusion therapy group consisted of 209 patients and the conservative therapy group of 269 patients. Both groups presented similar neurological status when they were admitted to hospital. However, the reperfusion therapy group had better neurological status (NIHSS 6.82) than in the conservative therapy group (NIHSS 8.2) at the time period when patients were discharged from hospital (p < 0.05). There were more cases of good functional outcome (39.2%) and less of poor (34.5%) in the reperfusion group, as well as less mortality-7.6%. Middle cerebral artery (MCA) is the most common site of stroke and the most common cause of its occlusion is cardioembolism. There is high incidence of recurrence of stroke due to M1 MCA occlusion. Both groups presented a similar neurological status on admission, but more improvement was seen in the reperfusion therapy group after discharge of patients from hospital. The functional outcome was also better in the reperfusion therapy group.Item 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, ZandaPasaules 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.