ADD-ONS / SCALES AND SCORES

AF-RoPE score

Anatomical-Functional Risk of Paradoxical Embolism score

Created 11/12/2022, last revision 18/01/2023

  • the discovery of a patent foramen ovale (PFO) in an individual stroke patient with an otherwise occult etiology is not synonymous with the diagnosis of paradoxical embolism
  • the RoPE and improved AF-RoPE scores were introduced to help establish the relationship between cryptogenic stroke and PFO
  • published data indicate that the RoPE score identifies cryptogenic stroke patients who are likely to have a pathogenic PFO
  • the AF-RoPE score enables a more precise separation of patients with RoPE score 8-10 using anatomical and functional features (Rigatteli, 2017)
    • it was demonstrated that right-to-left (R-L) shunt at rest, huge ASA (> 20 mm) ), long-tunnel PFO (> 12 mm), and massive R-L shunt on TCD/TCCD bubble test represent the highest risk of recurrent stroke
  • patients with AF-RoPE score >11 had more stroke recurrences and more strokes on baseline MRI than those ranging from 10 to 7 or less
  • large population studies are needed to validate this score regarding the efficacy and long-term outcomes
Patent Foramen Ovale (PFO)
  • step 1 – use the AF-RoPE score to predict which patients are likely to have had cryptogenic strokes that are attributable to PFO
  • step 2 – include other factors to decide whether PFO should be closed
Characteristic Points
no history of hypertension 1
no history of diabetes 1
no history of stroke or TIA 1
nonsmoker 1
cortical infarct on imaging 1
Functional and anatomical parameters
Curtain-type shunt
1
Permanent shunt (before Valsalva)
2
ASA 3-5
2
long-tunnel PFO
2
Age
18-29 5
30-39 4
40-49 3
50-59 2
60-69 1
≥ 70
0
Points (0-17)
  • maximum score 17
    • a patient < 30 y without vascular risk factors and a history of previous stroke/TIA
    • cortical infarct
    • long-tunnel PFO + permanent curtain-type shunt
  • minimum score 0 – a patient 70 y with vascular risk factors and subcortical lacunar infarct
Variables AF-RoPE
≤ 7 8-10 ≥ 11
History of recurrent stroke 10% 48% 85%
Multiple ischemic lesions on baseline MRI 3.4% 29% 68,5%
RoPE score The probability that PFO is the cause of stroke (95% CI)) Estimated stroke/TIA recurrence at 2 years
0-3 0% (0–4) 20% (12–28)
4 38% (25–48) 12% (6–18)
5 34% (21–45) 7% (3–11)
6 62% (54–68) 8% (4–12)
7 72% (66–76) 6% (2–10)
8 84% (79–87) 6% (2–10)
9-10 88% (83–91) 2% (0–4)
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AF-ROPE score
link: https://www.stroke-manual.com/af-rope-score/