Clot meniscus sign (angiography)
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- updated 18 Aug 2023:
Nothing to disclose
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Clot meniscus sign (angiography)
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The clot meniscus sign, or simply the meniscus sign, is a radiological sign appreciated on digital subtraction angiography in the setting of endovascular clot retrieval for acute ischaemic stroke caused by large vessel occlusion.
The sign describes the angiographic appearance of the proximal occluded site whereby it has a meniscoid or concaved appearance towards the proximal lumen 1-4. The claw sign is a variant of the clot meniscus sign, and specifically describes when the length of protruding contrast on either side of the meniscus is greater than half the diameter of the parent vessel 5.
The clot meniscus and claw signs may have clinical implications:
in both anterior and posterior circulation large vessel occlusion acute ischaemic stroke, patients with a positive clot meniscus sign may be more amenable to contact aspiration (cf. stent retriever) as the method for endovascular clot retrieval 1,3
in posterior circulation large vessel occlusion acute ischaemic stroke, presence of the clot meniscus sign may be associated with better angiographic outcome 2
in anterior circulation large vessel occlusion acute ischaemic stroke, presence of the clot meniscus sign has no bearing on outcomes 4
in both anterior and posterior circulation large vessel occlusion acute ischaemic stroke, presence of a positive claw sign may be associated with better angiographic outcome 5
- +<p>The <strong>clot meniscus sign</strong>, or simply the <strong>meniscus sign</strong>, is a radiological sign appreciated on <a href="/articles/digital-subtraction-angiography" title="Digital subtraction angiography">digital subtraction angiography</a> in the setting of <a href="/articles/endovascular-clot-retrieval-ecr" title="Endovascular clot retrieval (ECR)">endovascular clot retrieval</a> for acute <a href="/articles/ischaemic-stroke" title="Ischaemic stroke">ischaemic stroke</a> caused by <a href="/articles/large-vessel-occlusion" title="Large vessel occlusion">large vessel occlusion</a>.</p><p>The sign describes the angiographic appearance of the proximal occluded site whereby it has a meniscoid or concaved appearance towards the proximal lumen <sup>1-4</sup>. The <strong>claw sign</strong> is a variant of the clot meniscus sign, and specifically describes when the length of protruding contrast on either side of the meniscus is greater than half the diameter of the parent vessel <sup>5</sup>.</p><p>The clot meniscus and claw signs may have clinical implications:</p><ul>
- +<li><p>in both anterior and posterior circulation <a href="/articles/large-vessel-occlusion" title="Large vessel occlusion">large vessel occlusion</a> acute <a href="/articles/ischaemic-stroke" title="Ischaemic stroke">ischaemic stroke</a>, patients with a positive clot meniscus sign may be more amenable to <a href="/articles/contact-aspiration" title="contact aspiration">contact aspiration</a> (cf. <a href="/articles/stent-retriever" title="stent retriever">stent retriever</a>) as the method for endovascular clot retrieval <sup>1,3</sup></p></li>
- +<li><p>in posterior circulation <a href="/articles/large-vessel-occlusion" title="Large vessel occlusion">large vessel occlusion</a> acute <a href="/articles/ischaemic-stroke" title="Ischaemic stroke">ischaemic stroke</a>, presence of the clot meniscus sign may be associated with better angiographic outcome <sup>2</sup></p></li>
- +<li><p>in anterior circulation <a href="/articles/large-vessel-occlusion" title="Large vessel occlusion">large vessel occlusion</a> acute <a href="/articles/ischaemic-stroke" title="Ischaemic stroke">ischaemic stroke</a>, presence of the clot meniscus sign has no bearing on outcomes <sup>4</sup></p></li>
- +<li><p>in both anterior and posterior circulation <a href="/articles/large-vessel-occlusion" title="Large vessel occlusion">large vessel occlusion</a> acute <a href="/articles/ischaemic-stroke" title="Ischaemic stroke">ischaemic stroke</a>, presence of a positive claw sign may be associated with better angiographic outcome <sup>5</sup></p></li>
- +</ul>
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2024-02-20T04:04:20.753Z.
References changed:
- 1. Baik S, Jung C, Kim B, Han K, Kim D. Clot Meniscus Sign: An Angiographic Clue for Choosing Between Stent Retriever and Contact Aspiration in Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol. 2021;42(4):732-7. <a href="https://doi.org/10.3174/ajnr.a6988">doi:10.3174/ajnr.a6988</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33541894">Pubmed</a>
- 2. Baik S, Kim J, Kim B, Kim D. Significance of Angiographic Clot Meniscus Sign in Mechanical Thrombectomy of Basilar Artery Stroke. J NeuroIntervent Surg. 2019;12(5):477-82. <a href="https://doi.org/10.1136/neurintsurg-2019-015321">doi:10.1136/neurintsurg-2019-015321</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31594799">Pubmed</a>
- 3. Nie C, Kang Z, Tu M, Wu X, Sun D, Mei B. Clot Meniscus Sign Is Associated With Thrombus Permeability and Choice of Mechanical Thrombectomy Technique in Acute Middle Cerebral Artery Occlusion. Front Neurol. 2022;13:850429. <a href="https://doi.org/10.3389/fneur.2022.850429">doi:10.3389/fneur.2022.850429</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35280281">Pubmed</a>
- 4. Miranda A, Abdelnaby R, Araújo A et al. Meniscus Sign in Patients with Anterior Circulation Large Vessel Occlusion Stroke Does Not Predict Outcome. Clin Neuroradiol. 2022;33(1):65-72. <a href="https://doi.org/10.1007/s00062-022-01183-w">doi:10.1007/s00062-022-01183-w</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35750916">Pubmed</a>
- 5. Yamamoto Y, Yamamoto N, Kanematsu Y et al. The Claw Sign: An Angiographic Predictor of Recanalization After Mechanical Thrombectomy for Cerebral Large Vessel Occlusion. J Stroke Cerebrovasc Dis. 2019;28(6):1555-60. <a href="https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.007">doi:10.1016/j.jstrokecerebrovasdis.2019.03.007</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30930237">Pubmed</a>
Sections changed:
- Interventional Radiology
- Signs
Systems changed:
- Central Nervous System
- Vascular
Images Changes:
Image 1 DSA (angiography) (Basilar artery) ( create )
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Case 1
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Image 2 DSA (angiography) (Vertebral artery) ( create )
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