Management of percutaneous coronary intervention complications

Learning objectives 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. ### Traumatic coronary dissection Coronary dissection is a pathological separation of the layers of the vessel. Traumatic coronary dissection can be induced by the guide catheter, wire manipulation, equipment in the coronary artery (imaging probes, ‘mother-and-child catheters’) or excessive balloon and stent expansion. Guide catheter-induced dissection affects the ostioproximal segment of the vessel initially but may extend retrogradely into the aortic root or propagate down the coronary artery. Ostial disease and supportive guide catheters, particularly in patients with small aortic root dimensions, increase the risk of dissection. Careful attention should be paid to guide …