TIMI flow grade 0: Difference between revisions

	Coronary Angiography
Home
General Principles Overview ; Historical Perspective ; Contraindications ; Appropriate Use Criteria for Revascularization ; Complications ; Technique ; Film Quality
Anatomy & Projection Angles
Normal Anatomy Coronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus
Anatomic Variants Separate Ostia Anomalous Origins Case Example Fistula
Projection Angles Standard Views Left Coronary Artery Right Coronary Artery
Epicardial Flow & Myocardial Perfusion
Epicardial Flow TIMI Frame Count ; TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration
Myocardial Perfusion TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3
Lesion Complexity
ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis
Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6
Lesion Morphology Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration
Left ventriculography

VisualWikitext

Latest revision as of 15:34, 3 May 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: TIMI 0, TIMI 0 flow, TIMI 0 flow grade, TFG 0, TFG0

Overview

TIMI Grade 0 flow is defined as no perfusion. There is no antegrade flow beyond the point of occlusion.^[1] ^[2] ^[3]

Example

Shown below are an animated image and a static image depicting TIMI flow grade 0 in the RCA. Outlined in blue in the second image is the flow of the dye which completely stops at the level of the stenosis. Outlined with a yellow dashed line is the pathway that the dye would have filled in case the stenosis was absent.

Additional Examples

Click here for other examples of TIMI flow grade 0.

References

↑ Gibson, CM; Ryan, K; Sparano, A; Rizzo, M; Moynihan, J; Kelley, M; Marble, SJ; Dodge, JT; Antman, EM. Methodologic drift in the assessment of TIMI grade 3 flow and its implications with respect to the reporting of angiographic trial results. Am Heart J. 1999;137:1179–1184. PMID 10347349
↑ Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996 Mar 1;93(5):879-88. PMID 8598078
↑ Gibson CM, Murphy S, Menown IB, Sequeira RF, Greene R, Van de Werf F, Schweiger MJ, Ghali M, Frey MJ, Ryan KA, Marble SJ, Giugliano RP, Antman EM, Cannon CP, Braunwald E. Determinants of coronary blood flow after thrombolytic administration. TIMI Study Group. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1999 Nov 1;34(5):1403-12. PMID 10551685

Template:WikiDoc Sources

[Gibson-1] Gibson, CM; Ryan, K; Sparano, A; Rizzo, M; Moynihan, J; Kelley, M; Marble, SJ; Dodge, JT; Antman, EM. Methodologic drift in the assessment of TIMI grade 3 flow and its implications with respect to the reporting of angiographic trial results. Am Heart J. 1999;137:1179–1184. PMID 10347349

[Gibson2-2] Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996 Mar 1;93(5):879-88. PMID 8598078

[Gibson3-3] Gibson CM, Murphy S, Menown IB, Sequeira RF, Greene R, Van de Werf F, Schweiger MJ, Ghali M, Frey MJ, Ryan KA, Marble SJ, Giugliano RP, Antman EM, Cannon CP, Braunwald E. Determinants of coronary blood flow after thrombolytic administration. TIMI Study Group. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1999 Nov 1;34(5):1403-12. PMID 10551685

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{SI}}
+{{Coronary angiography2}}
 {{CMG}}
+{{SK}} TIMI 0, TIMI 0 flow, TIMI 0 flow grade, TFG 0, TFG0
 ==Overview==
-The TIMI flow grading system is a widely used method of grading coronary flow.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = The Thrombolysis in Myocardial Infarction (TIMI... [N Engl J Med. 1985] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed?term=((%22The%20New%20England%20journal%20of%20medicine%22%5BJournal%5D)%20AND%20312%5BVolume%5D)%20AND%20TIMI%5BTitle%5D | publisher =  | date =  | accessdate = 29 August 2013 }}</ref>
+TIMI Grade 0 flow is defined as no perfusion. There is no antegrade flow beyond the point of occlusion.<ref name="Gibson"> Gibson, CM; Ryan, K; Sparano, A; Rizzo, M; Moynihan, J; Kelley, M; Marble, SJ; Dodge, JT; Antman, EM. Methodologic drift in the assessment of TIMI grade 3 flow and its implications with respect to the reporting of angiographic trial results. Am Heart J. 1999;137:1179–1184. PMID 10347349</ref> <ref name="Gibson2">Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996 Mar 1;93(5):879-88. PMID 8598078</ref> <ref name="Gibson3">Gibson CM, Murphy S, Menown IB, Sequeira RF, Greene R, Van de Werf F, Schweiger MJ, Ghali M, Frey MJ, Ryan KA, Marble SJ, Giugliano RP, Antman EM, Cannon CP, Braunwald E. Determinants of coronary blood flow after thrombolytic administration. TIMI Study Group. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1999 Nov 1;34(5):1403-12. PMID 10551685</ref>
-While the [[TMPG]] that was invented by [[C. Michael Gibson]] M.S., M.D.assesses  perfusion in the capillary bed at the tissue level,<ref name="pmid10637197">{{cite journal| author=Gibson CM, Cannon CP, Murphy SA, Ryan KA, Mesley R, Marble SJ et al.| title=Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. | journal=Circulation | year= 2000 |volume= 101 | issue= 2 | pages= 125-30 | pmid=10637197 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10637197  }} </ref> the TIMI flow grade is used to assess epicardial coronary blood flow.
-==Definition==
+==Example==
-No perfusion. No antegrade flow beyond the point of occlusion.<ref name="Gibson"> Gibson, CM; Ryan, K; Sparano, A; Rizzo, M; Moynihan, J; Kelley, M; Marble, SJ; Dodge, JT; Antman, EM. Methodologic drift in the assessment of TIMI grade 3 flow and its implications with respect to the reporting of angiographic trial results. Am Heart J. 1999;137:1179–1184. PMID 10347349</ref> <ref name="Gibson2">Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996 Mar 1;93(5):879-88. PMID 8598078</ref> <ref name="Gibson3">Gibson CM, Murphy S, Menown IB, Sequeira RF, Greene R, Van de Werf F, Schweiger MJ, Ghali M, Frey MJ, Ryan KA, Marble SJ, Giugliano RP, Antman EM, Cannon CP, Braunwald E. Determinants of coronary blood flow after thrombolytic administration. TIMI Study Group. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1999 Nov 1;34(5):1403-12. PMID 10551685</ref>
+Shown below are an animated image and a static image depicting TIMI flow grade 0 in the [[RCA]].  Outlined in blue in the second image is the flow of the dye which completely stops at the level of the stenosis.  Outlined with a yellow dashed line is the pathway that the dye would have filled in case the stenosis was absent.
-==TIMI Frame Count in the Setting of TIMI Flow Grade 1==
+[[Image:TFG-0-RCA.gif|300px|TIMI flow grade 0 in RCA]]
-In the case of a TIMI Flow Grade 0, 1, or 1.5 there is no measurable TIMI Frame Count; therefore, DNA (Does Not Apply) is recorded on the case report form in the TIMI Frame Count field.
+[[Image:TFG0RCA-static.gif|300px|TIMI flow grade 0 in RCA: Outlined in blue in the second image is the flow of the dye which completely stops at the level of the stenosis; outlined with a yellow dashed line is the pathway that the dye would have filled in case the stenosis was absent.]]
+==Additional Examples==
+Click '''[[TIMI flow grade 0 case studies|here]]''' for other examples of TIMI flow grade 0.
 ==References==

v t e Coronary Angiography
Coronary Anatomy	Normal coronary anatomy • Anomalous origins of coronary arteries (Left coronary artery • Right coronary artery) • Congenital abnormalities of coronary arteries • Coronary artery segments • Cinefilm frame speed • Coronary artery dominance (Left dominance • Right dominance • Co-dominance)
TIMI Flow Grade	TIMI flow grade 0 • TIMI flow grade 1 • TIMI flow grade 2 • TIMI flow grade 3
TIMI Frame Count	TFC for SVG • TIMI Myocardial Frame Count • Washout TIMI Frame Count
TIMI Myocardial Perfusion Grade	TIMI MPG 0 • TIMI MPG 1 • TIMI MPG 2 • TIMI MPG 3
Thrombus Grading	Thrombus Grade 0 • Thrombus Grade 1 • Thrombus Grade 2 • Thrombus Grade 3 • Thrombus Grade 4 • Thrombus Grade 5 • Thrombus Grade 6
Lesion Complexity	Type A • Type B₁ • Type B₂ • Type C
Dissection Classification	Type A • Type B • Type C • Type D • Type E • Type F
Coronary Collaterals	Grade 0 • Grade 1 • Grade 2 • Grade 3 • Rentrop and Cohen’s Collateral Classification
Lesion Morphology	Myocardial bridge •Definitions of Preprocedural Lesion Morphology • Luminal irregularities • Disease extent • Arterial foreshortening • Infarct related artery (Culprit lesion) • Reocclusion • Restenosis • Degenerated saphenous vein graft • Coronary artery fistula
Angiographic complications	Distal embolization • Coronary spasm • Abrupt closure • Side branch loss • Slow flow • No-reflow • Pulsatile flow • Flow deceleration • Ectasia • Intimal flap • Staining •
Performing Coronary Angiography	Patient preparation • Catheter selection • Standard angiographic views • High risk groups • Patients with special need • Access site closure (Manual compression • Assisted compression • Closure devices) •
Quantitative Coronary Angiography (QCA)	Minimal lumen diameter • Percent stenosis • Reference diameter • Lesion length • Residual stenosis • Average reference segment diameter • Plaque area • Plaque volume •
Contrast Media	High-osmolar contrast media • Iso-osmolar contrast media • Low-osmolar contrast media
Left Ventriculography & Aortography	Ejection fraction • Aortography • Quantitative Left Ventricular Analysis (LAO projection • RAO projection • LVA) • Left Ventricular Wall Motion Analysis (Normokinesia • Hypokinesia • Akinesia • Dyskinesia • Aneurysm) • Evaluation of mitral regurgitation • Evaluation of aortic regurgitation
Right Heart Catheterization	Pressure waveforms (Right atrial pressure • Rirght ventricular pressure • Pulmonary artery pressure • Pulmonary artery wedge-pressure) • Endomyocardial biopsy
Complications	Access site complications • Dumping • Contrast hypersensitivity • Contrast induced nephropathy • Hypotension • Hypertension • Dissection • Vessel perforation • Acute myocardial infarction • Ventricular fibrillation • Cardiac arrest • Stroke • ASD • VSD • Pulmonary emboli • Myocardial rupture • Peripheral arterial emboli • Radiation injury


Coronary Angiography
Home

General Principles Overview Historical Perspective Contraindications Appropriate Use Criteria for Revascularization Complications Technique Film Quality

Anatomy & Projection Angles

Normal Anatomy Coronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus

Anatomic Variants Separate Ostia Anomalous Origins Case Example Fistula

Projection Angles Standard Views Left Coronary Artery Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow TIMI Frame Count TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration

Myocardial Perfusion TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6

Lesion Morphology Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration

Left ventriculography

Technique Quantification of LV Function Quantification of Mitral Regurgitation