TIMI thrombus grade 6

	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

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview[edit | edit source]

In TIMI Grade 6 thrombus, a chronic total occlusion is present.^[1]

The characteristics of a chronic total occlusion are:

The occlusion does not have a "beak like" appearance, and the occlusion has a blunt cut-off/edge.
Extensive collaterals may be present.
The clot generally propagates backwards up the proximal vessel to the nearest proximal side branch.

Shown below are an animated image an a static image depicting TIMI grade 6 thrombus in the left circumflex. Encircled in yellow in the image on the right is the thrombus, where you can notice an abrupt blunt cut-off appearance. Outlined in yellow in the same image on the right is the path of the dye in a collateral artery arising from the LAD.

Shown below are two animated images of the same case depicting TIMI grade 6 thrombus in the left circumflex. The image on the left shows the same thrombus before PCI and the image on the left shows the patent left circumflex after PCI.

Additional Examples[edit | edit source]

Click here for other examples on TIMI thrombus grade 6.

References[edit | edit source]

↑ 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.

[pmid11382722-1] 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.

[1]

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

TIMI thrombus grade 6

Overview[edit | edit source]

Example[edit | edit source]

Additional Examples[edit | edit source]

References[edit | edit source]