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Comparative Outcomes of Novel Small Balloon Low-Pressure Pullback and Traditional Management for Coronary Intramural
Chen Chen1, Ziyi Ni1, Juetong Zhu1
1Department of Cardiology, Wenzhou Municipal Key Cardiovascular Research Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Insights
The small balloon low-pressure pullback technique (SBLP) offers improved cardiac function and shorter hospital stays for percutaneous coronary intervention-related coronary intramural hematoma (CIMH). SBLP also resulted in fewer major adverse cardiovascular events compared to conventional treatments.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Percutaneous coronary intervention (PCI)-related coronary intramural hematoma (CIMH) management is debated.
- Conventional strategies like additional stenting/cutting balloon (AS/CB) or conservative management (CM) have limitations.
- Comparative evidence for the small balloon low-pressure pullback technique (SBLP) is limited.
Purpose of the Study:
- To compare in-hospital and long-term outcomes of AS/CB, CM, and SBLP for CIMH.
- Evaluate the efficacy of SBLP against established CIMH management strategies.
- Assess impacts on cardiac biomarkers, function, hospitalization, and major adverse cardiovascular events (MACEs).
Main Methods:
- Retrospective cohort study of 181 patients with CIMH post-PCI.
- Management groups: AS/CB (n=109), CM (n=20), SBLP (n=52).
- Primary endpoints: Troponin I, LVEF, stent use, hospitalization stay/costs, MACEs.
Main Results:
- SBLP and AS/CB groups showed decreased troponin I; CM group showed increased troponin I.
- Left ventricular ejection fraction (LVEF) improved with SBLP and AS/CB; decreased with CM.
- SBLP demonstrated the shortest hospital stay (5 days) and lowest MACE incidence (7.7%) over 15.1 months.
- AS/CB had the highest stent utilization.
Conclusions:
- SBLP shows significant potential benefits over conventional CIMH management.
- SBLP is associated with improved cardiac function, reduced hospitalization duration, and fewer stents.
- SBLP demonstrates superior long-term outcomes with a significantly lower MACE risk compared to CM and AS/CB.
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.