To evaluate the correlation between the Risk of Paradoxical Embolism (ROPE) score and PFO closure eligibility criteria derived from CLOSE, REDUCE, and RESPECT, three trials published in September 2017 demonstrating superiority of PFO closure over medical management for secondary stroke prevention.

The ROPE Score stratifies the likelihood that a cryptogenic stroke patient’s PFO is stroke-related vs incidental. In 2017, three randomized controlled trials of patients with cryptogenic embolic stroke and higher-risk PFO demonstrated reduced recurrent stroke in patients undergoing PFO closure.

We retrospectively reviewed the electronic medical record of patients evaluated in our institution’s stroke clinic to identify patients with cryptogenic stroke and PFO. For patients with PFO, we abstracted patient demographics, stroke subtype, and PFO characteristics.  ROPE scores were then calculated and dichotomized into high-probability (scores 6-10) and low-probability (scores 0-5) that the PFO was stroke-related. Using the Fisher’s Exact Test, the high probability and low probability cohorts were assessed for correlation with generalized eligibility/ineglibility for the CLOSE, REDUCE and RESPECT trials.

Thirty-four (13%) of 262 stroke clinic patients had PFO. The mean ROPE score was 5.59 (SD ±2.24). Eight (24%) patients had high risk PFO and 6 (18%) patients met clinical trial criteria for PFO closure.  ROPE scores did not correlate with PFO closure criteria (Fisher’s Extract P-value = 0.19).   

The ROPE did not correlate with PFO closure clinical trial eligibility criteria. Further research is needed to investigate the utility of the ROPE score as a tool, in combination with PFO-specific characteristics, for the appropriate selection of cryptogenic embolic stroke patients who may benefit from PFO-closure.