Key result
Small balloon low-pressure pullback technique linked to ~94% lower MACE risk versus conservative management.
Why the study?
Optimal management of PCI-related coronary intramural hematoma is debated, conventional strategies have limitations, and comparative evidence for the newer small balloon low-pressure pullback technique is limited.
Does the small balloon low-pressure pullback technique improve clinical and procedural outcomes in patients with coronary intramural hematoma complicating PCI compared to conventional management?
Cohort (n=181)
Does the small balloon low-pressure pullback technique improve clinical and procedural outcomes in patients with coronary intramural hematoma complicating PCI compared to conventional management?
Hazard Ratio: 0.06 (95% CI 0.018–0.21)
Absolute Event Rate: 7.7% vs 50%
p-value: p=<0.001
The small balloon low-pressure pullback technique is associated with improved cardiac function, shorter hospitalization, fewer stents, and lower long-term MACE risk compared to conventional management for PCI-related coronary intramural hematoma.
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.
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Chen et al. (2026) conducted a cohort in PCI-related coronary intramural hematoma (CIMH) (n=181). Small balloon low-pressure pullback technique (SBLP) vs. Conservative management (CM) and additional stenting with/without cutting balloon (AS/CB) was evaluated on Major adverse cardiovascular events (MACEs) (HR 0.060, 95% CI 0.018-0.210, p=<0.001). The small balloon low-pressure pullback technique was associated with a lower risk of MACE compared to conservative management (7.7% vs 50%; HR 0.060; 95% CI 0.018-0.210; p<0.001).
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