During a percutaneous coronary intervention (PCI) on a patient with ST-segment myocardial infarction (STEMI) the tumor burden can be graded using the TIMI (thrombolysis in myocardial infarction) schema.
Patient selection: STEMI
Parameters:
(1) angiographic evidence of thrombus
(2) maximum dimension of thrombus (including length) in vessel diameter(s)
(3) vascular occlusion
Angiographic Evidence
Maximum Dimension
Vascular Occlusion
Grade
none
NA
NA
0
suggestive
NA
NA
1
definite
< 0.5 vessel
partial
2
definite
0.5 to 1.99 vessels
partial
3
definite
> 2 vessels
partial
4
definite
NA
complete
5
where:
• Angiographic features suggestive of thrombus: decreased contrast density, haziness of contrast, irregular lesion contour, smooth convex meniscus at the site of total occlusion
• A definite thrombus appears in multiple angiographic views.
• A complete thrombotic occlusion has a convex margin that stains with contrast and that persists for several cardiac cycles.
Interpretation:
• A TIMI grade from 1 to 3 indicates a low thrombus burden.
• A TIMI grade of 4 or 5 indicates a high thrombus burden.
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