The RoPE score is commonly associated with PFO (Patent Foramen Ovale) and cryptogenic stroke: it stands for Risk of Paradoxical Embolism.
The RoPE score helps clinicians determine how likely a PFO is to be the cause of a patient’s stroke, rather than an incidental finding.
RoPE Score Components The score is calculated based on clinical and imaging features:
Total score ranges from 0 to 10.
A higher RoPE score means the PFO is more likely to be stroke-related (PFO-attributable) rather than incidental.
Generally: High score (7–10): PFO likely caused the stroke — closure may be beneficial
Low score (0–3): PFO is likely incidental — treating other risk factors is the priority.
Higher scores (7-10) indicate a higher likelihood of PFO-related stroke and lower 2-year recurrence risk, while lower scores (0-3) suggest the stroke is likely unrelated to the PFO.
RoPE Score Interpretation & Likelihood of Pathogenic PFO
• 0–3 (Low): Negligible likelihood (less than 25%) that the stroke is attributable to the PFO. • 4–6 (Intermediate): Moderate likelihood (approx. 34%–62%). • 7–10 (High): High likelihood (up to 88%) that the PFO is the cause.
The RoPE score is particularly useful when deciding whether a patient with a cryptogenic stroke should undergo PFO closure (e.g., via catheter-based closure devices), which has been shown to reduce recurrent stroke in appropriately selected patients.
High Scores (≥7): Patients are younger, lack traditional cardiovascular risk factors (no hypertension, smoking, or diabetes), and have cortical strokes.
Low Scores (≤3): Patients are often older and have alternative risk factors (e.g., smoking, vascular risk factors), suggesting the PFO is an incidental finding.
Clinical Utility: A high score (>6) suggests a higher likelihood that the PFO is pathogenic (causal) and that the patient might benefit from PFO closure.
Recurrence: Counterintuitively, higher RoPE scores are associated with lower 2-year stroke/TIA recurrence.
The RoPE score should be used in conjunction with anatomical, imaging findings, such as large shunts or atrial septal aneurysms.