Percutaneous coronary intervention (PCI) has revolutionised the management of coronary artery disease. Advances in equipment and technique have led to a steady increase in both the volume and complexity of PCIs performed. Fortunately, complications remain rare, and most can be managed effectively through percutaneous means. However, in the subset of patients where percutaneous strategies are unsuccessful, emergency cardiac surgery remains the final bailout option. The unpredictable nature of PCI complications and the lack of standardised management algorithms underscores the need for cardiothoracic surgeons to be familiar with both the technical aspects of PCI-related events and their percutaneous treatment options. This chapter provides a comprehensive overview of major PCI complications that may necessitate emergency cardiac surgery, including coronary perforation, coronary dissection, iatrogenic aortic dissection, and equipment entrapment and loss. For each, we review the epidemiology, pathophysiology, classification, clinical sequelae, prognosis, and available percutaneous management strategies. Emphasis is placed on considerations relevant to surgical planning and intervention. A thorough understanding of these rare but potentially life-threatening complications is essential for interventional cardiologists, cardiothoracic surgeons, and the entire heart team to ensure optimal patient outcomes during the acute phase of care.