Objective To analyze the relationship between TCD foam test grading and risk of paradoxical embolism (RoPE) score in patients with ischemic stroke caused by patent foramen ovale (PFO).

Methods The clinical data of 249 patients with ischemic stroke were retrospective analyzed. The TCD foam test, head MRI and heart color ultrasound were performed to evaluate the correlation between the severity of PFO found by TCD foam test and RoPE scores.

Results There was no statistical significance in the gender, heart disease, hyperhomocysteinemia and hyperlipidemia in ischemic stroke patients with PFO and without PFO (P ＞ 0.05). The differences of the age, hypertension, diabetes, smoking, history of cortical infarction, stroke or TIA, and RoPE scores between ischemic stroke patients with PFO and without PFO were statistically significant (P ＜ 0.05 to P ＜ 0.01). The RoPE score was positively correlated with TCD foam test grading (RoPE score 1–4 points, RLS positive rate 28%; RoPE score 5–6 points, RLS positive rate 42.48%; RoPE score 7–10 points, RLS positive rate 75.58%).

Conclusions The TCD foam test grading is positively correlated with RoPE score in ischemic stroke patients with PFO.