PFO-Associated Stroke Causal Likelihood (PASCAL) Classification System
Assesses stroke causality due to patent foramen ovale (PFO) by combining RoPE Score and high-risk features.
Advice
Patient selection for PFO closure should be a shared decision between neurology and cardiology, integrating PASCAL results with the full diagnostic work-up.
Management
If the likelihood that the stroke is attributable to a PFO is classified as:
- Possible or probable: Consider PFO closure for secondary prevention.
- Unlikely: Focus on alternative etiologies and guideline-directed antithrombotic and vascular risk-factor management; closure may not be beneficial.
Critical Actions
Always exclude other or contributing stroke mechanisms (e.g., atrial fibrillation, hypercoagulable states) before attributing causality to the PFO.