Trial reportStroke2020
Risk of Paradoxical Embolism (RoPE)-Estimated Attributable Fraction Correlates With the Benefit of Patent Foramen Ovale Closure: An Analysis of 3 Trials.
Trial report in Stroke, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 44 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Medical Treatment With or Without Transcatheter Patent Foramen Ovale CloSure for Older Patients With CrypTogenic StrOke and Patent Foramen Ovale. The STOP Trial
Pioneering Advancements in Cardiocerebrovascular Interactions in the Asia pacFIC - Patent Foramen Ovale Study
Who cites it
44 citing papers in PubMed, 92 citations in OpenAlex.
- Percutaneous closure strategy in patients with patent foramen ovale and coexisting small atrial septal defect: a single-center experience.Cardiovascular intervention and therapeutics · 2026Article
- Incremental Predictive Value of the Non-HDL-C/HDL-C Ratio for Cryptogenic Stroke in Patients with Patent Foramen Ovale.Journal of cardiovascular development and disease · 2026Article
- Patent foramen ovale, bone cement implantation syndrome and paradoxical embolism : Case study and pathophysiological aspects.Die Anaesthesiologie · 2026Article
- Incidence and outcome of paediatric cardioembolic stroke: a nationwide population-based study.European stroke journal · 2026Article
- Diagnosis and Management of Patent Foramen Ovale for Stroke Prevention: An Australian and New Zealand Consensus Statement Developed by a Modified Nominal Group Approach.The Medical journal of Australia · 2026Article
- Comparison of safety and short-term outcomes of septostomy and direct tunnel passage techniques in percutaneous patent foramen ovale closure: a multicenter experience.Frontiers in cardiovascular medicine · 2026Article
- Cost-Effectiveness and Budget Impact of Cardioform versus Amplatzer and Medical Therapy Alone for Patent Foramen Ovale Closure: A UK Payer Perspective.ClinicoEconomics and outcomes research : CEOR · 2026Article
- Rare Pediatric Posterior Stroke Case Report with Discussion of Brainstem Lesions.Neurology international · 2025Article
- Review
- Article
- Percutaneous Closure of Patent Foramen Ovale in Ischemic Stroke: A Single-Center Experience.Acta Cardiologica Sinica · 2025Article
- Morphotype-based risk stratification in patients with patent foramen ovale using computational fluid dynamics.Scientific reports · 2025Article
- Patent Foramen Ovale Closure in Older Patients With Cryptogenic Stroke: Current Evidence and Next Steps.Structural heart : the journal of the Heart Team · 2025Review
- Stroke recurrence after transcatheter PFO closure in patients with cryptogenic stroke.International journal of stroke : official journal of the International Stroke Society · 2025Article
- PFO-ACCESS: Augmenting Communications for Medical Care or Closure in the Evaluation of Patients With Stroke With Cardiac Shunts.Stroke (Hoboken, N.J.) · 2025Article
- Cardiac CT in Large Vessel Occlusion Stroke for the Evaluation of Non-Thrombotic and Non-Atrial-Fibrillation-Related Embolic Causes.Neurology international · 2025Article
- Multimodal data-based longitudinal prognostic model for predicting atrial fibrillation recurrence after catheter ablation in patients with patent foramen ovale and paroxysmal atrial fibrillation.European journal of medical research · 2025Article
- Predictive value of patent foramen ovale diameter for cryptogenic stroke and age-related differences.Frontiers in cardiovascular medicine · 2025Article
- Clinical research progress on pathogenesis and treatment of Patent Foramen Ovale-associated stroke.Frontiers in neurology · 2025Review
- Multisystem embolism in hereditary protein C deficiency with patent foramen ovale: a case report.Frontiers in cardiovascular medicine · 2025Article
Corrections and comments
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Authors and funding
11 authors at 8 institutions in 4 countries.
Funding
Abstract
background and purposeIn patients with cryptogenic stroke and patent foramen ovale (PFO), the Risk of Paradoxical Embolism (RoPE) Score has been proposed as a method to estimate a patient-specific "PFO-attributable fraction"-the probability that a documented PFO is causally-related to the stroke, rather than an incidental finding. The objective of this research is to examine the relationship between this RoPE-estimated PFO-attributable fraction and the effect of closure in 3 randomized trials.
methodsWe pooled data from the CLOSURE-I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale), RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment), and PC (Clinical Trial Comparing Percutaneous Closure of Patent Foramen Ovale [PFO] Using the Amplatzer PFO Occluder With Medical Treatment in Patients With Cryptogenic Embolism) trials. We examine the treatment effect of closure in high RoPE score (≥7) versus low RoPE score (<7) patients. We also estimated the relative risk reduction associated with PFO closure across each level of the RoPE score using Cox proportional hazard analysis. We estimated a patient-specific attributable fraction using a PC trial-compatible (9-point) RoPE equation (omitting the neuroradiology variable), as well as a 2-trial analysis using the original (10-point) RoPE equation. We examined the Pearson correlation between the estimated attributable fraction and the relative risk reduction across RoPE strata.
resultsIn the low RoPE score group (<7, n=912), the rate of recurrent strokes per 100 person-years was 1.37 in the device arm versus 1.68 in the medical arm (hazard ratio, 0.82 [0.42-1.59]
conclusionsThe RoPE score estimated attributable fraction is highly correlated to the relative risk reduction of device versus medical therapy. This observation suggests the RoPE score identifies patients with cryptogenic stroke who are likely to have a PFO that is pathogenic rather than incidental.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.