Introduction

In the 40 years since Gruntzig’s first angioplasty,1 percutaneous coronary intervention (PCI) has become one of the most frequently performed therapeutic interventions in medicine.2 Devices and techniques have evolved during this period and facilitated improved patient outcomes, so unlike Gruntzig it is no longer necessary to have a cardiac surgeon present for every procedure. However, these advancements have resulted in the treatment of increasingly complex patient populations, including acute coronary syndrome, chronic total occlusion (CTO), calcified coronary disease and cardiogenic shock. Consequently, despite improved device and procedural safety, complications associated with PCI continue to be encountered. It is of paramount importance that interventional cardiologists are equipped with the knowledge and skills required to rapidly recognise complications, and have strategies to overcome them, thereby minimising the risk of injury to their patients.

It is important to recognise that all invasive vascular interventions are associated with a risk of bleeding and vascular injury; however, for the purpose of this review, we will focus only on complications relating specifically to coronary intervention.