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Original research
Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke
  1. Sung Hyun Baik1,2,
  2. Joon Whi Kim2,
  3. Byung Moon Kim2,
  4. Dong Joon Kim2
  1. 1 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea, Seongnam, Korea (the Republic of)
  2. 2 Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Dong Joon Kim, Department of Radiology, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, South Korea; djkimmd{at}


Introduction The relationship between the occlusive clot morphology and the efficacy of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) is not well known. Our aim was to evaluate the clinical significance of the clot meniscus sign in patients with acute BAO.

Methods 89 patients with acute BAO who underwent MT were retrospectively analyzed. The clot meniscus sign was defined as meniscoid/tram-track like antegrade side-wall contrast opacification of the thrombus. Patients were assigned to two groups based on the presence of the clot meniscus sign. The treatment and clinical outcomes were compared.

Results The clot meniscus sign was diagnosed in 62.9% (53/89) of the patients. The meniscus sign (+) group showed a shorter procedure time (55 vs 85 min; p=0.045), higher rate of successful recanalization (89.3% vs 63.6%, p=0.004), higher incidence of first pass effect (32.1% vs 6.1%, p=0.004), and lower number of passes (2 vs 3; p=0.042) when compared with the meniscus sign (−) group. The procedure time (OR 0.972, 95% CI 0.962 to 0.992; p=0.003) and clot meniscus sign (OR 7.920, 95% CI 1.769 to 35.452; p=0.007) were independent predictors of successful recanalization.

Conclusion The clot meniscus sign is related to high first pass effect and short procedure time and is a reliable predictor of successful recanalization in patients with acute BAO.

  • angiography
  • stroke
  • thrombectomy

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  • Contributors Substantial contribution to the conception or design of the work: DJK. Acquisition, analysis, or interpretation of the data for the work: SHB, JK, BMK, DJK. Drafting the work or revising it critically for important intellectual content: SHB, JK, BMK, DJK. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SHB, JK, BMK, DJK.

  • Funding Supported by the Research Institute of Radiological Science, Yonsei University College of Medicine (grant 4-2017-0672).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The relevant anonymized patient level data are available on reasonable request from the authors.

  • Patient consent for publication Not required.