A recent study published in JAMA Neurology, co-authored by David Thaler, MD, PhD, Chairman Emeritus of Neurology at Tufts Medical Center and Professor at Tufts University School of Medicine, and David Kent, MD, Director of the Predictive Analytics and Comparative Effectiveness (PACE) Center at the Institute for Clinical Research and Health Policy Studies (ICRHPS) and Professor of Neurology and Clinical and Translational Science at Tufts University School of Medicine, highlights a promising approach to improving care for patients with patent foramen ovale (PFO) associated stroke.
Dr. Thaler and Dr. Kent have contributed extensively to research examining the relationship between PFO and stroke and were co-developers of the widely used Risk of Paradoxical Embolism (RoPE) Score, a tool that helps estimate the likelihood that a PFO is causally related to a patient’s stroke.
Published as a meta-analysis of six major randomized trials, the research evaluated the PFO-Associated Stroke Causal Likelihood (PASCAL) classification system to better identify which patients benefit most from PFO closure. While closure is known to reduce recurrent stroke, it also carries an increased risk of atrial fibrillation—making patient selection critical.
The study found that the PASCAL system can effectively distinguish patients likely to experience net benefit from those at risk of harm. Among individuals classified as “probable” or “possible,” PFO closure reduced recurrent stroke rates more than it increased atrial fibrillation. In contrast, patients in the “unlikely” category saw no reduction in stroke and experienced higher rates of atrial fibrillation.
Overall, the findings suggest that as many as 4 out of 5 patients may benefit from PFO closure when guided by PASCAL classification, while approximately 1 in 5 may be exposed to unnecessary risk.
These results support the use of more personalized, evidence-based decision-making in stroke prevention, helping clinicians better target interventions and improve long-term outcomes for younger and middle-aged patients.
Learn how predictive analytics is advancing stroke care at the PACE Center at Tufts Medicine.
