This narrative review summarizes PCI complications, noting acute vessel closure reduced from ~3% to 0.3% between balloon angioplasty and contemporary PCI eras due to advances in stent technology and antithrombotic therapy.
Introduction 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. Methods This narrative review used a focused PubMed search through October 2025, prioritizing randomized trials, large observational studies, guidelines, and consensus statements. Results 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. Conclusions 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.
Attachaipanich et al. (Thu,) conducted a review in Patients undergoing percutaneous coronary intervention (PCI), including those with complex lesions and acute coronary syndromes. This narrative review summarizes PCI complications, noting acute vessel closure reduced from ~3% to 0.3% between balloon angioplasty and contemporary PCI eras due to advances in stent technology and antithrombotic therapy.
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