The utility of the RoPE score in cryptogenic stroke patients ≤50 years in predicting a stroke-related patent foramen ovale

Prefasi, Daniel; Martínez-Sánchez, Patricia; Fuentes, Blanca; Díez‐Tejedor, Exuperio

doi:10.1177/1747493015607505

Cited by 32 publications

(22 citation statements)

References 4 publications

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“…The Risk of Paradoxical Embolism (RoPE) score was used to differentiate between patients with a high probability of a stroke-related PFO (high attributable risk) vs. an incidental PFO. ( 26 , 28 ) The RoPE score is externally validated ( 28 , 29 ) and varies from 0 to 9 points with higher scores indicating a higher attributable risk. In stroke patients with PFO and a RoPE score >5 points, the PFO has an attributable risk for stroke of 62% or more ( 28 ).…”

Section: Methodsmentioning

confidence: 99%

Early Recurrent Ischemic Lesions in Patients With Cryptogenic Stroke and Patent Foramen Ovale: An Observational Study

et al. 2018

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Background: Randomized controlled trials indicate that patent foramen ovale (PFO) closure reduces risk of stroke recurrence in patients with cryptogenic stroke and PFO. However, the optimal time point for PFO closure is unknown and depends on the risk of stroke recurrence.Objective: We aimed to investigate risk of early new ischemic lesions on cerebral magnetic resonance imaging (MRI) in cryptogenic stroke patients with and without PFO.Methods: Cryptogenic stroke patients underwent serial MRI examinations within 1 week after symptom onset to detect early new ischemic lesions. Diffusion-weighted imaging (DWI) lesions were delineated, co-registered, and analyzed visually for new hyperintensities by raters blinded to clinical details. A PFO was classified as stroke-related in patients with PFO and a Risk of Paradoxical Embolism (RoPE) score >5 points.Results: Out of 80 cryptogenic stroke patients, risk of early recurrent DWI lesions was not significantly different in cryptogenic stroke patients with and without PFO. Similar results were observed in patients ≤60 years of age. Patients with a stroke-related PFO even had a significantly lower risk of early recurrent ischemic lesions compared to all other patients with cryptogenic stroke (unadjusted odds ratio 0.23 [95% confidence interval 0.06–0.87], P = 0.030).Conclusion: Our data argue against a high risk of early stroke recurrence in patients with cryptogenic stroke and PFO.

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Section: Methodsmentioning

confidence: 99%

Early Recurrent Ischemic Lesions in Patients With Cryptogenic Stroke and Patent Foramen Ovale: An Observational Study

et al. 2018

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“…Nevertheless, its efficacy has been tested in clinical practice; the fact that the risk of stroke recurrence was still high after PFO closure in patients with low RoPE score indicates that the stroke mechanism was indeed unrelated to PFO (62). A study in CS patients ≤50 years reported that RoPE score above 7 is the optimal limit for identifying a causative relationship of PFO and CS (63). It should be emphasized though, that the RoPE score does not characterize the risk of stroke associated with PFO individually, but it rather provides a guide to define whether the relationship of PFO with CS after the index event is causative or not (6).…”

Section: The Rope Score and Pfo As An Incidential Findingmentioning

confidence: 99%

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Ioannidis

Mitsias

2020

Front. Neurol.

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Patent foramen ovale (PFO) has been associated with cryptogenic stroke. There is conflicting data and it remains uncertain whether PFO is the direct cause, a risk factor or an incidental finding. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signaling disruption. Main risk factors linked with PFO-attributable strokes are young age, PFO size, right-to-left shunt degree, PFO morphology, presence of atrial septal aneurysm, intrinsic coagulation-anticoagulation systems imbalance, and coexistence of other atrial abnormalities, such as right atrial septal pouch, Eustachian valve and Chiari's network. These may act independently or synergistically, multiplying the risk of embolic events. The RoPE score, a scale that includes factors such as young age, cortical infarct location and absence of traditional stroke risk factors, is associated with the probability of a PFO being pathogenic and stroke recurrence risk after the index stroke. Multiple investigators have attempted to correlate other PFO features with the risk of PFO-related stroke, but further investigation is needed before any robust conclusions are reached. PFO presence in young patients with cryptogenic stroke should be considered as etiologically suspect. Caution should be exercised in interpreting the relevance of other PFO features.

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“…The RoPE (Risk of Paradoxical Embolism) score has been developed and validated as an assessment tool to determine the probability that a PFO is responsible for a cryptogenic stroke 49, 50. It can be used when assessing patients with a PFO preceding closure (Table 2).…”

Section: Patient Selectionmentioning

confidence: 99%

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Collado

Poulin

Murphy

et al. 2018

JAHA

101

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The utility of the RoPE score in cryptogenic stroke patients ≤50 years in predicting a stroke-related patent foramen ovale

Cited by 32 publications

References 4 publications

Early Recurrent Ischemic Lesions in Patients With Cryptogenic Stroke and Patent Foramen Ovale: An Observational Study

Early Recurrent Ischemic Lesions in Patients With Cryptogenic Stroke and Patent Foramen Ovale: An Observational Study

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

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