**10. Percutaneous coronary intervention: technical aspects and challenges**

Stent implantation in the setting of NSTE-ACS helps to reduce abrupt vessel closure and restenosis associated with balloon angioplasty and it should be considered the standard treatment strategy (**Figure 3** and movies online). New-generation drug eluting stents are recommended over bare metal stents in NSTE-ACS [159–161]. Dual antiplatelet therapy (DAPT) is recommended for 12 months irrespective of stent type, but DAPT may be extended depending on the number of stents and the total stents' length used, patients with high risk of ischemic events recurrence and if patient's bleeding risk is low. The benefit of thrombectomy has not been assessed prospectively in NSTE-ACS but cannot be recommended, considering the lack of benefit observed in STEMI [162].

Complications of PCI include PCI-induced MI; coronary perforation, dissection, or rupture; cardiac tamponade; malignant arrhythmias; cholesterol emboli; and bleeding from the access site. Contrast-induced nephropathy is a common and potentially serious complication, especially in patients with baseline impaired renal function [163]. Early and late stent thromboses are catastrophic complications. Radial access, performed by experienced operators, is associated with lower bleeding risk and recommended over the transfemoral access in ACS [164, 165].

**Figure 3.** Angiogram of 54 years old gentleman presented with NSTEMI, ECG showed ST depression in the anterior leads. The angiogram confirmed a severe stenotic lesion in the proximal LAD (A) which stented successfully (B). Video clips of the angiogram available online.
