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 TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3ĪCC/AHA Lesion-Specific Classification of the Primary Target Stenosis 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 Standard Views Left Coronary Artery Right Coronary Artery Separate Ostia Anomalous Origins Case Example Fistula 2012 Mar 33(6):768-75.Appropriate Use Criteria for RevascularizationĬoronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial. 2012 Mar 13 59(11):991-7.Ĭlaessen BE, Dangas GD, Weisz G, Witzenbichler B, Guagliumi G, Möckel M, Brener SJ, Xu K, Henriques JP, Mehran R, Stone GW. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. 2017 Jul-Sep 18(3):109-114.įefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, Gannot S, Samuel M, Weisbrod M, Bierstone D, Sparkes JD, Wright GA, Strauss BH. Risk Factors for Coronary Artery Disease: Historical Perspectives. Primary success, restenosis, and long-term clinical follow-up. Percutaneous transluminal coronary angioplasty of chronic total occlusions. Ivanhoe RJ, Weintraub WS, Douglas JS, Lembo NJ, Furman M, Gershony G, Cohen CL, King SB. Clinical findings through hospital discharge. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. However, in many patients, the age of the CTO cannot be determined with confidence.Ĭopyright © 2023, StatPearls Publishing LLC.Ĭhesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Ludbrook P. Therefore, it is mostly estimated based on available clinical information related to the timing of the event that caused the occlusion, for example, prior myocardial infarction or sudden change in anginal symptoms with electrocardiogram changes consistent with the location of the occlusion. Moreover, it is difficult to identify the exact period over which a CTO lesion is present in the absence of serial angiograms. TIMI 3 flow (full perfusion) - normal flow, which fills the distal coronary bed.Ī "true" CTO is defined as 100% occlusion of a coronary artery with TIMI 0 flow whereas a "functional" CTO is defined as severely stenotic, yet, less than a 100% occlusion of the coronary artery with TIMI 1 flow for a duration of greater than or equal to 3 months based on angiographic evidence. TIMI 2 flow (partial reperfusion) - delayed forward flow with complete filling of the distal coronary bed. TIMI 1 flow (penetration without perfusion) - faint forward flow beyond the occlusion, associated with an incomplete filling of the distal coronary bed. TIMI 0 flow (no perfusion-complete occlusion) - the absence of any forward flow beyond a coronary occlusion. The TIMI flow grading system is as below: The TIMI (thrombolysis in myocardial infarction) flow grading system is a scoring classification from 0-3 referring to the levels of coronary blood flow assessed during coronary angiography. A coronary chronic total occlusion (CTO) is defined as 100% occlusion of a coronary artery for a duration of greater than or equal to 3 months based on angiographic evidence.
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