The Small Balloon Low-Pressure Pullback Technique: A Novel Approach for Managing Coronary Intramural Hematoma During Percutaneous Coronary Intervention

A coronary intramural hematoma (CIMH) is a potentially life-threatening complication of percutaneous coronary intervention (PCI), often resulting in compromised distal blood flow. Traditional management strategies, including additional stenting, cutting balloon angioplasty, and conservative treatment, have shown inconsistent efficacy and may even exacerbate the condition. We present the small balloon low-pressure pullback (SBLP) technique, a novel approach designed for hematoma evacuation, involving gently squeezing and pulling the hematoma back toward the proximal segment, thereby restoring distal flow. In this case series, we report the successful application of the SBLP technique in four patients with CIMH during PCI. The Thrombolysis in Myocardial Infarction (TIMI) flow grade was used to determine the efficacy of the procedure. All four patients had TIMI III flow after the procedure, indicating complete restoration of distal blood flow. Our findings suggest that the SBLP technique is a promising, minimally invasive approach for managing CIMH, as it restores blood flow with minimal risk of iatrogenic injury. This technique may be an effective alternative to conventional management methods for CIMH. However, further research, including randomized controlled trials, is warranted to validate these results and establish the long-term efficacy and safety of the SBLP technique.