Fundamentals of coronary interventional complications

Author(s): Jeffrey Cook

In the practice of interventional cardiology, a comprehensive awareness of the complications associated with Percutaneous Coronary Intervention (PCI), and strategies to both prevent and treat them, is an absolute necessity as one matures into a complete operator. This can be likened to the process that occurs as one develops from a beginning to experienced automobile driver. The vast majority of PCI cases are going to be straightforward and easy to navigate, such as a leisurely drive to the supermarket, with minimal twists and turns. A basic, well-planned PCI procedure will often seem just as comfortable. However, no matter how well a procedure is planned and executed, the reality is that at any point, the unexpected can occur an access site complication, coronary dissection, or even a procedural death. The early career interventionalist will logically be less prepared for this, as a student driver attempting to merge onto the interstate for the first time. These occurrences can be fraught with anxiety and selfdoubt. Importantly, with time and experience, one will become quick in recognizing and managing complications. This results in improved patient outcomes, increased breadth of procedural knowledge, and higher physician satisfaction. Strategies to avoid complications will become incorporated into routine practice. This review provides a guideline of common PCI complications, along with measures to both prevent and treat them, should they occur.