Cor Vasa 2026, 68(4):481-485 | DOI: 10.33678/cor.2026.024

Sekundárna prevencia ischemickej cievnej mozgovej príhody pri foramen ovale patens.

Juraj Dúbrava

Oddelenie neinvazívnej kardiológie, Nemocnica sv. Cyrila a Metoda, Univerzitná nemocnica Bratislava, Bratislava, Slovensko

Patent foramen ovale (PFO) is probably responsible for 5% of all ischemic strokes and 10% of strokes in young and middle-aged people aged 18-60 years. The assessment of the association between PFO and cryptogenic stroke is always only probabilistic. Currently, the best tool for assessing this probability is the PASCAL system (PFO-Associated Stroke Causal Likelihood). It is a simple and effective tool for selecting patients who have the highest benefit from transcatheter closure of PFO and the lowest risk of complications. The PASCAL classification is determined using the RoPE score (Risk of Paradoxical Embolism) and echocardiographic risk characteristics of PFO - atrial septal aneurysm and right-left shunt intensity. It can be used to determine five levels of association between PFO and cryptogenic stroke: definite, highly probable, probable, possible, and unlikely association. In patients aged 18-60 years with a possible or probable association of PFO with cryptogenic stroke, transcatheter PFO closure and dual antiplatelet therapy for 1 to 6 months, followed by single antiplatelet therapy for 5 years, is recommended after exclusion of other causes of stroke. Patients with an atrial septal aneurysm and/or a large right-to-left shunt benefit most from PFO closure. © 2026, ČKS.

Keywords: Ischemic stroke, PASCAL classification system, Patent foramen ovale, Transcatheter closure

Received: February 16, 2026; Revised: February 16, 2026; Accepted: March 14, 2026; Prepublished online: August 3, 2026; Published: August 31, 2026  Show citation