Comparative Outcomes of Novel Small Balloon Low‐Pressure Pullback and Traditional Management for Coronary Intramural Hematoma Complicating PCI
Chen Chen, Ziyi Ni, Juetong Zhu, Yaoxue Zang, Qianli Zhu, Guangze Xiang, Li‐You Lian, Yinuo LinABSTRACT
Background and Aims
The management of percutaneous coronary intervention (PCI)‐related coronary intramural hematoma (CIMH) is debated. Conventional strategies—additional stenting with/without cutting balloon (AS/CB) or conservative management (CM)—have limitations. The small balloon low‐pressure pullback technique (SBLP) is a newer option, but comparative evidence is limited. This study compared in‐hospital and long‐term outcomes among AS/CB, CM, and SBLP.
Methods
In this retrospective cohort study, 181 patients who developed CIMH during PCI between January 2022 and December 2025 were enrolled. Patients were managed with AS/CB ( n = 109), CM ( n = 20), or SBLP ( n = 52). Primary endpoints included myocardial injury biomarkers (troponin I), cardiac function recovery (LVEF), stent utilization, hospitalization stay and costs, and major adverse cardiovascular events (MACEs).
Results
Post‐procedural troponin I levels decreased significantly in the AS/CB and SBLP groups (all p < 0.05) but increased significantly in the CM group ( p < 0.05). LVEF improved postoperatively in the AS/CB and SBLP groups (all p < 0.05) but decreased in the CM group ( p < 0.05). Hospital stay was shortest with SBLP (median 5.0 days) versus CM (10.0) and AS/CB (7.0). Stent use was highest with AS/CB (total length 77.0 mm; 3.0 stents) versus others ( p < 0.05). Over 15.1 months, MACE incidence was lowest with SBLP (7.7%) versus AS/CB (29.4%) and CM (50%; p < 0.001). Adjusted hazard ratios confirmed lower MACE risk: SBLP versus CM, HR 0.060, 95% CI 0.018–0.210, p < 0.001; AS/CB versus CM, HR 0.385, 95% CI 0.174–0.853, p = 0.019.
Conclusion
SBLP shows potential benefits over conventional CIMH management, with improved cardiac function, shorter hospitalization, fewer stents, and better long‐term outcomes.