Risk of Paradoxical Embolism (RoPE) Score
Identifies stroke-related PFO in patients with cryptogenic stroke.
Use in patients with cryptogenic stroke found to have PFO and no other compelling cause for stroke.
Advice
- Decisions regarding which patients should be selected for PFO closure should be carefully weighed by the treating neurologist and cardiologist. The RoPE Score provides important information about the probable biological mechanism, which is key for making mechanism-specific therapeutic decisions, such as whether to close a PFO or treat with medication alone. Additional studies are necessary to better motivate firmer decision rules for patient selection.
- Consult cardiology for patients in whom suspicion for PFO-attributable stroke is high based on the RoPE score.
Management
Consider referral for PFO closure in appropriately-selected patients with higher RoPE scores.
Critical Actions
Do not forget to rule out other, or contributing, causes for stroke (e.g. hypercoagulable state).