Percutaneous coronary intervention (PCI) is currently indicated for the management of patients presenting with acute coronary syndrome and in individuals with chronic stable angina that is refractory to optimal medical therapy. Advances in devices, stent design, adjunctive tech- nology, development of more potent and effective antiplatelet therapy, and judicious use of PCI are increasing the safety of the procedure. However, major periprocedural complications during PCI still occur. These problems can be related to the access site, intubation of the coronary artery ostia, or the intervention itself. In the current review, we describe possible complications during PCI, focusing on those occurring in the context of coronary intubation and target vessel or site intervention, including coro- nary perforation, abrupt vessel closure (AVC), stent deformation (and loss), wire fracture (and loss), device embolization, and rotational atherectomy burr entrapment. Management of these complications is predominantly based on operator experience and small case series with limited available guidance in the literature on account of their relative rarity. Therefore, we intend to provide recommendations relating to the practical aspects of their timely recogni- tion and treatment.