During the era of thrombolysis, a group of researchers at Brigham and Women’s Hospital devised a framework for describing the flow of contrast through coronary vessels. The group named themselves the TIMI (Thrombolysis In Myocardial Infarction) Group, and therefore the framework is called TIMI Grade Flow.
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Note that TIMI grade flow describes the flow of contrast. This is a separate (complementary) framework to grading the stenosis severity as a percentage between 0 and 100%.
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Before PCI, TIMI 0
LAO cranial showing only a tiny stump of vessel with 100% thrombotic occlusion proximally.
LAO cranial showing only a tiny stump of vessel with 100% thrombotic occlusion proximally.
After PCI, TIMI flow
LAO cranial showing a dominant RCA with three overlapping stents from proximal to distal.
LAO cranial showing a dominant RCA with three overlapping stents from proximal to distal.
This patient’s ECG did not meet STEMI criteria, although it does show inferoposterior OMI.
Before PCI, TIMI 1
RAO caudal showing peri-stent thrombosis with the narrowest stenosis just proximal to the stent edge.
After PCI, TIMI 3
RAO caudal showing post PCI TIMI 3 flow, but with some residual stenosis. There are wires in the LAD and LCx.
Before PCI, TIMI 2
LAO showing a very severe stenosis in the mid RCA. Contrast passes into the distal vessel, but slowly.
After PCI, much faster dye flow (TIMI 3)
LAO showing TIMI 3 flow after placement of overlapping stents from proximal to distal RCA.
LAO showing TIMI 3 flow after placement of overlapping stents from proximal to distal RCA.
This patient had a STEMI (+) OMI despite having TIMI 2 flow.
