Anatomic landmarks used for TIMI frame counting in the LAD. The distal-most branch in the LAD (referred to as the "pitchfork," "mustache," or "whale's tail") usually occurs at the apex of the heart. In a wraparound LAD, the branch closest to the apex of the heart is used.
Anatomic landmarks used for TIMI frame counting in the LCx. The branch of the LCx used for TIMI frame counting is determined as follows: The artery used for TIMI frame counting is the artery with the longest total distance along which dye travels in the LCx system and yet passes through the culprit lesion. When the culprit lesion is proximal to two arteries with equal total dye-path distances, the artery that arises more distally from the LCx is used. For example, when the culprit lesion is located in the proximal LCx, the marginal branch with the longest total dye path distance is used, regardless of whether it is the first, second, or third marginal branch. If these second and third marginals have equal total dye path distances, the third marginal branch is the target artery. The target artery is always the first marginal branch when the culprit lesion is in the first marginal and, likewise, always the second marginal branch when the culprit lesion is in the second marginal. In left and balanced dominant systems, the target artery is no further distal than the marginal branch that lies at the border of the inferior and lateral walls, usually the third or fourth marginal. The anatomic end point is the distal-most branch in the target artery. Usually this end-point branch can be found at approximately the midpoint of the distal third of the artery (five sixths of the distance down the vessel from its origin), but occasionally it is located just before the termination of the artery.
Anatomic landmarks used for TIMI frame counting in the RCA. The distal landmark is the first branch arising from the posterior lateral extension of the RCA after the origin of the posterior descending artery, regardless of the size of this branch. As shown, this branch will often be located just distal to the bifurcation and may be oriented either superiorly (RU) or inferiorly (RL). In some cases, this branch will lie further along the extension of the distal RCA and either will course superiorly as the AV nodal artery (AV) or will be oriented inferiorly as the right inferior branch (RI). In the event that a very proximal posterior descending stenosis is the culprit lesion, the first branch off the posterior descending artery after the stenosis is the end point. Infrequently the distal portion of the posterior descending artery is supplied by a proximally arising acute marginal branch, and the proximal portion of the posterior descending artery arises at the base of the heart. In these cases, it is the extension of the distal RCA past the posterior descending artery at the base of the heart and not the proximal acute marginal branch that is used for determining the TIMI frame count. In patients with left-dominant anatomy, the TIMI frame count end point is the distal-most branch off the RCA once it is no longer in the AV groove.
Anatomic landmarks used for TIMI frame counting in the LCx. The branch of the LCx used for TIMI frame counting is determined as follows: The artery used for TIMI frame counting is the artery with the longest total distance along which dye travels in the LCx system and yet passes through the culprit lesion. When the culprit lesion is proximal to two arteries with equal total dye-path distances, the artery that arises more distally from the LCx is used. For example, when the culprit lesion is located in the proximal LCx, the marginal branch with the longest total dye path distance is used, regardless of whether it is the first, second, or third marginal branch. If these second and third marginals have equal total dye path distances, the third marginal branch is the target artery. The target artery is always the first marginal branch when the culprit lesion is in the first marginal and, likewise, always the second marginal branch when the culprit lesion is in the second marginal. In left and balanced dominant systems, the target artery is no further distal than the marginal branch that lies at the border of the inferior and lateral walls, usually the third or fourth marginal. The anatomic end point is the distal-most branch in the target artery. Usually this end-point branch can be found at approximately the midpoint of the distal third of the artery (five sixths of the distance down the vessel from its origin), but occasionally it is located just before the termination of the artery.
Anatomic landmarks used for TIMI frame counting in the RCA. The distal landmark is the first branch arising from the posterior lateral extension of the RCA after the origin of the posterior descending artery, regardless of the size of this branch. As shown, this branch will often be located just distal to the bifurcation and may be oriented either superiorly (RU) or inferiorly (RL). In some cases, this branch will lie further along the extension of the distal RCA and either will course superiorly as the AV nodal artery (AV) or will be oriented inferiorly as the right inferior branch (RI). In the event that a very proximal posterior descending stenosis is the culprit lesion, the first branch off the posterior descending artery after the stenosis is the end point. Infrequently the distal portion of the posterior descending artery is supplied by a proximally arising acute marginal branch, and the proximal portion of the posterior descending artery arises at the base of the heart. In these cases, it is the extension of the distal RCA past the posterior descending artery at the base of the heart and not the proximal acute marginal branch that is used for determining the TIMI frame count. In patients with left-dominant anatomy, the TIMI frame count end point is the distal-most branch off the RCA once it is no longer in the AV groove.
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