Melanie R. F. Greenway, MD
Strambo D, Sirimarco G, Nannoni S, Perlepe K, Ntaios G, Vemmos K, Michel P. Embolic Stroke of Undetermined Source and Patent Foramen Ovale: Risk of Paradoxical Embolism Score Validation and Atrial Fibrillation Prediction. Stroke. 2021;52:1643–1652.
In patients with embolic stroke of undetermined source (ESUS), patent foramen ovale (PFO) is often suspected as a potential mechanism. Recent clinical trials have shown the benefit of PFO closure when patients are properly selected.1-3 Present in 25% of the normal population, when found in the etiology workup for stroke, the most important question to ask is whether this is a pathogenic or incidental finding. The Risk of Paradoxical Embolism (RoPE) score is a commonly used clinical decision tool to estimate the likelihood of PFO as the cause of stroke. The higher the score, the more likely the PFO is the cause of stroke. Using this score, it is also possible to predict whether a patient actually has a PFO.
In this study, the authors used three independent, international, multicenter stroke registries (ASTRAL, Athens, and Larissa Stroke Outcome Registry) to validate the RoPE score in patients with ESUS to predict both the presence of PFO and the ability to determine if the PFO is the cause of the stroke or not. It is the largest validation cohort of patients with ESUS for the RoPE score to date. They also followed the patients for a period of time to evaluate for incident atrial fibrillation and recurrent stroke.