Among patients with Stroke and PatentForamenOvale, the PASCAL classification system identified those likely to benefit from closure and those at risk of increased atrial fibrillation.

Question Among young and middle-aged individuals (ages 18–60 years) with patent foramen ovale (PFO) and otherwise cryptogenic ischemic stroke enrolled in pivotal trials, can the PASCAL classification system identify those who will experience net benefit and those who will experience net harm from PFO closure in the next 5 years?

Finding This meta-analysis showed that in the PASCAL groups probable and possible, PFO closure reduced recurrent ischemic stroke more often than it caused atrial fibrillation, but in the unlikely group, closure did not reduce stroke and caused a larger amount of atrial fibrillation.

Meaning The PASCAL classification system may identify as many as 4 of 5 patients who will experience net benefit and 1 of 5 who will experience net harm from PFO closure.