TIMI thrombus grade: Difference between revisions
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==Thrombus Grades== | ==Thrombus Grades== | ||
In order to more objectively and quantitatively characterize [[thrombus]] on a coronary angiogram, the [http://ww.perfuse.org PERFUSE study group] developed the following [[thrombus]] grading system:<ref name="pmid11382722">{{cite journal| author=Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP et al.| title=Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. | journal=Circulation | year= 2001 | volume= 103 | issue= 21 | pages= 2550-4 | pmid=11382722 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11382722 | In order to more objectively and quantitatively characterize [[coronary artery thrombus|thrombus]] on a coronary angiogram, the [http://ww.perfuse.org PERFUSE study group] developed the following [[coronary artery thrombus|thrombus]] grading system:<ref name="pmid11382722">{{cite journal| author=Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP et al.| title=Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. | journal=Circulation | year= 2001 | volume= 103 | issue= 21 | pages= 2550-4 | pmid=11382722 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11382722 }} </ref> | ||
===[[ | ===[[TIMI thrombus grade 0 | TIMI Thrombus Grade 0]]=== | ||
No cineangiographic characteristics of [[thrombus]] present. | No cineangiographic characteristics of [[coronary artery thrombus|thrombus]] present. | ||
===[[ | ===[[TIMI thrombus grade 1 | TIMI Thrombus Grade 1]]=== | ||
Hazy, possible [[thrombus]] present. Angiography demonstrates characteristics such as reduced contrast density, haziness, irregular lesion contour, or a smooth convex "meniscus" at the site of total occlusion suggestive but not diagnostic of [[thrombus]]. | Hazy, possible [[coronary artery thrombus|thrombus]] present. Angiography demonstrates characteristics such as reduced contrast density, haziness, irregular lesion contour, or a smooth convex "meniscus" at the site of total occlusion suggestive but not diagnostic of [[coronary artery thrombus|thrombus]]. | ||
===[[ | ===[[TIMI thrombus grade 2 | TIMI Thrombus Grade 2]]=== | ||
[[ | [[coronary artery thrombus|thrombus]] present – small size: Definite [[coronary artery thrombus|thrombus]] with greatest dimensions less than or equal to 1/2 vessel diameter. | ||
===[[ | ===[[TIMI thrombus grade 3 | TIMI Thrombus Grade 3]]=== | ||
[[ | [[coronary artery thrombus|thrombus]] present – moderate size: Definite [[coronary artery thrombus|thrombus]] but with greatest linear dimension greater than 1/2 but less than 2 vessel diameters. | ||
===[[ | ===[[TIMI thrombus grade 4 | TIMI Thrombus Grade 4]]=== | ||
[[ | [[coronary artery thrombus|thrombus]] present – large size: As in Grade 3 but with the largest dimension greater than or equal to 2 vessel diameters. | ||
===[[ | ===[[TIMI thrombus grade 5 | TIMI Thrombus Grade 5]]=== | ||
Recent total occlusion, can involve some collateralization but usually does not involve extensive collateralization, tends to have a “beak” shape and a hazy edge or appearance of distince thrombus. | Recent total occlusion, can involve some collateralization but usually does not involve extensive collateralization, tends to have a “beak” shape and a hazy edge or appearance of distince thrombus. | ||
===[[ | ===[[TIMI thrombus grade 6 | TIMI Thrombus Grade 6]]=== | ||
[[ | [[TIMI thrombus grade 6 | Chronic total occlusion]], usually involving extensive collateralization, tends to have distinct, blunt cut-off/edge and will generally clot up to the nearest proximal side branch. | ||
==Natural History, Complications, Prognosis== | ==Natural History, Complications, Prognosis== | ||
The presence of angiographically evident thrombus (AET) as assessed using the [http://www.perfuse.org PERFUSE] Grade described above is associated with embolization and impaired myocardial perfusion.<ref name="pmid16847010">{{cite journal| author=Kirtane AJ, Vafai JJ, Murphy SA, Aroesty JM, Sabatine MS, Cannon CP et al.| title=Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 17 | pages= 2040-5 | pmid=16847010 | doi=10.1093/eurheartj/ehl149 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16847010 | The presence of angiographically evident thrombus (AET) as assessed using the [http://www.perfuse.org PERFUSE] Grade described above is associated with embolization and impaired myocardial perfusion.<ref name="pmid16847010">{{cite journal| author=Kirtane AJ, Vafai JJ, Murphy SA, Aroesty JM, Sabatine MS, Cannon CP et al.| title=Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 17 | pages= 2040-5 | pmid=16847010 | doi=10.1093/eurheartj/ehl149 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16847010 }} </ref><ref name="pmid15642554">{{cite journal| author=Kirtane AJ, Weisbord A, Karmpaliotis D, Murphy SA, Giugliano RP, Cannon CP et al.| title=Relation of impaired Thrombolysis In Myocardial Infarction myocardial perfusion grades to residual thrombus following the restoration of epicardial patency in ST-elevation myocardial infarction. | journal=Am J Cardiol | year= 2005 | volume= 95 | issue= 2 | pages= 224-7 | pmid=15642554 | doi=10.1016/j.amjcard.2004.09.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15642554 }} </ref> | ||
==References== | ==References== | ||
Revision as of 16:24, 14 November 2013
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Coronary Angiography | |
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General Principles | |
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Anatomy & Projection Angles | |
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Normal Anatomy | |
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Anatomic Variants | |
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Projection Angles | |
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Epicardial Flow & Myocardial Perfusion | |
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Epicardial Flow | |
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Myocardial Perfusion | |
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Lesion Complexity | |
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ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis | |
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Lesion Morphology | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Thrombus Grades
In order to more objectively and quantitatively characterize thrombus on a coronary angiogram, the PERFUSE study group developed the following thrombus grading system:[1]
TIMI Thrombus Grade 0
No cineangiographic characteristics of thrombus present.
TIMI Thrombus Grade 1
Hazy, possible thrombus present. Angiography demonstrates characteristics such as reduced contrast density, haziness, irregular lesion contour, or a smooth convex "meniscus" at the site of total occlusion suggestive but not diagnostic of thrombus.
TIMI Thrombus Grade 2
thrombus present – small size: Definite thrombus with greatest dimensions less than or equal to 1/2 vessel diameter.
TIMI Thrombus Grade 3
thrombus present – moderate size: Definite thrombus but with greatest linear dimension greater than 1/2 but less than 2 vessel diameters.
TIMI Thrombus Grade 4
thrombus present – large size: As in Grade 3 but with the largest dimension greater than or equal to 2 vessel diameters.
TIMI Thrombus Grade 5
Recent total occlusion, can involve some collateralization but usually does not involve extensive collateralization, tends to have a “beak” shape and a hazy edge or appearance of distince thrombus.
TIMI Thrombus Grade 6
Chronic total occlusion, usually involving extensive collateralization, tends to have distinct, blunt cut-off/edge and will generally clot up to the nearest proximal side branch.
Natural History, Complications, Prognosis
The presence of angiographically evident thrombus (AET) as assessed using the PERFUSE Grade described above is associated with embolization and impaired myocardial perfusion.[2][3]
References
- ↑ Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP; et al. (2001). "Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy". Circulation. 103 (21): 2550–4. PMID 11382722.
- ↑ Kirtane AJ, Vafai JJ, Murphy SA, Aroesty JM, Sabatine MS, Cannon CP; et al. (2006). "Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy". Eur Heart J. 27 (17): 2040–5. doi:10.1093/eurheartj/ehl149. PMID 16847010.
- ↑ Kirtane AJ, Weisbord A, Karmpaliotis D, Murphy SA, Giugliano RP, Cannon CP; et al. (2005). "Relation of impaired Thrombolysis In Myocardial Infarction myocardial perfusion grades to residual thrombus following the restoration of epicardial patency in ST-elevation myocardial infarction". Am J Cardiol. 95 (2): 224–7. doi:10.1016/j.amjcard.2004.09.007. PMID 15642554.