# A practical approach to the management of percutaneous coronary intervention complications

## TL;DR

This paper reviews how to manage complications from heart procedures called PCI, focusing on prevention and treatment strategies to improve patient outcomes.

## Contribution

The paper provides a comprehensive review of current evidence and knowledge gaps in managing PCI complications, emphasizing the need for improved risk modeling and individualized strategies.

## Key findings

- Acute vessel closure and device-related complications in PCI are rare but lead to significant morbidity and mortality.
- Preventive strategies like lesion preparation and imaging can reduce PCI complication risks.
- Current management strategies rely heavily on case reports and expert consensus due to low event incidence.

## Abstract

Despite advances in stent design, pharmacotherapy, and procedural techniques that have improved percutaneous coronary intervention (PCI) outcomes and reduced PCI-related complications, these events still occur and are associated with adverse outcomes. Moreover, complex PCI procedures, which predispose to increased risk of complications, are increasingly performed. Understanding risk factors, underlying mechanisms, evidence-based management, and preventive strategies are essential to optimize procedural outcomes. This review aims to summarize current evidence and highlight gaps in knowledge related to PCI-associated complications.

This narrative review used a focused PubMed search through October 2025, prioritizing randomized trials, large observational studies, guidelines, and consensus statements.

Acute vessel closure, which most commonly results from dissection or thrombosis and perforation are frequently associated with hemodynamic compromise and increased procedural mortality. Device-related complications such as entrapment and fracture, although rare, can potentially lead to significant morbidity and mortality. Preventive strategies emphasize appropriate lesion preparation, proper device selection and sizing, gentle manipulation, and the use of adjunctive imaging modalities such as intravascular ultrasound and optical coherence tomography to minimize risk. Early recognition and prompt management of these complications are essential to decreased adverse outcomes of PCI in both short and long term. However, due to the low incidence of these events, current management strategies are largely based on case reports, observational studies, and expert consensus.

Future large-scale studies and registry data, along with artificial intelligence-guided risk modeling are warranted to facilitate individualized prediction, enhance procedural safety, and advance precision management across preprocedural, intraprocedural and postprocedural phases.

PCI-Related Complications and Management Strategies. This schematic summarizes major complications associated with percutaneous coronary intervention (PCI), including iatrogenic coronary artery dissection, coronary perforation, no-reflow phenomenon, and device entrapment. Created in BioRender. Attachaipanich T. (2026) https://BioRender.com/mpuf12a, licensed under Academic License.Diagram of PCI-related complications with four sections: iatrogenic coronary artery dissection, coronary artery perforation, no reflow phenomenon, and device entrapment. Each section lists causes, methods, and incidences. Includes elements like stents, guidewires, and hemodynamic support strategies. A central heart illustration connects the sections.

PCI-Related Complications and Management Strategies. This schematic summarizes major complications associated with percutaneous coronary intervention (PCI), including iatrogenic coronary artery dissection, coronary perforation, no-reflow phenomenon, and device entrapment. Created in BioRender. Attachaipanich T. (2026) https://BioRender.com/mpuf12a, licensed under Academic License.