PFO Closure Risk (RoPE) Score Calculator

PFO Closure Risk (RoPE) Score: Explanation and Clinical Context The RoPE (Risk of Paradoxical Embolism) score is a validated 10-point tool designed for patients with cryptogenic ischemic stroke in whom a patent foramen ovale (PFO) is detected. It estimates how likely the index stroke is causally related to the PFO (rather than incidental) and contextualizes the expected 2-year recurrence risk under medical management. The score assigns points for younger age and the absence of vascular risk factors (no hypertension, no diabetes, nonsmoking), no prior stroke/TIA, and the presence of a cortical infarct on neuroimaging.

Higher scores (especially ≥7) indicate a higher probability that the stroke is PFO-related, whereas lower scores suggest the PFO is more likely incidental. Importantly, as the score increases the PFO-attributable fraction rises (approaching ~88% for scores 9–10), while the observed 2-year recurrence tends to be lower compared with low-score strata. These relationships reflect that patients whose index event is most plausibly PFO-mediated often have fewer competing stroke mechanisms and a relatively benign recurrence profile on medical therapy, whereas patients with low scores likely harbor non-PFO causes with higher recurrence.

The RoPE score does not incorporate anatomic PFO risk features (e.g., large right-to-left shunt or atrial septal aneurysm) or concurrent venous thromboembolism. For closure decision-making, many groups therefore pair RoPE with an anatomic/clinical framework (e.g., PASCAL) and randomized-trial evidence, integrating patient age, stroke mechanism work-up, PFO features, and bleeding/device considerations.