Thread by @khasim_mohd_96

◾Patent Foramen Ovale(PFO) and Cryptogenic Stroke: A short thread 🧵

🔶PFO is present in nearly 25% of general population

🔶Risk of Ischemic stroke due to PFO is low despite it's high prevalence

🔶 Hence it is important to determine whether PFO is incidental or causal

🔶First step in establishing causality is to exclude other mechanisms by performing relevant diagnostic testing

🔶These include brain imaging, intracranial and extracranial vascular imaging, ECG, cardiac telemetry and atleast 30 days of outpatient cardiac rhythm monitoring

🔶In patients with PFO after excluding high-risk ischemic stroke mechanisms :
• Researchers have suggested use of RoPE Score and PASCAL Classification System to help determine whether PFO is pathogenic or incidental in the causation of Cryptogenic Stroke

🔶RoPE Score and PASCAL Classification System:

🔶RoPE stands for Risk of Paradoxical Embolism Score

🔶 Components include Age, History of HTN, DM, Stroke/TIA, Smoking and cortical infarct on imaging

🔶Higher the RoPE Score higher the likelihood of PFO to be pathogenic in causation of stroke

•Eg: RoPE Score of 10 : A 22 year old young patient non-smoker with PFO p/w ischemic stroke with no H/o DM, HTN, previous stroke/TIA with cortical infarct on imaging - High Likelihood

🔶PASCAL stands for PFO-Associated Stroke Causal Likelihood Classification System which adds high-risk PFO characteristics to the RoPE Score

🔶 High-risk PFO characteristics include:
- presence of substantial shunt
- presence of atrial septal aneurysm

🔶PASCAL Classification System classifies PFO pathogenicity into unlikely, possible, propable

🔶 Benefits from several trials showed benefit from PFO closure with a RoPE Score >7 or classified as PASCAL possible and probable

Special mention to @ContinuumAAN @ShadiYaghi2 @LyellJ @caseyalbin @GreenJournal

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