A dilemma occurs when a patient has undergone PCI and then unexpectedly requires noncardiac surgery. Many patients can undergo surgery on DAPT, where the risk-benefit ratio will favor continued dual antiplatelet inhi- bition. If it is necessary to hold P2Y12 inhibitor therapy, most clinicians will still continue aspirin uninterrupted during the perioperative period if the bleeding risk is not prohibitive. When the risk of delaying surgery or performing surgery while the patient is on DAPT exceeds the risk of stent thrombosis from stopping DAPT, the P2Y12 inhibitor is stopped before surgery and resumed as soon as possible afterward. No P2Y12 inhibitor bridging strategy (eg, GP IIb/IIIa inhibitor, antithrombin therapy) has been validated. 5.3. Coronary Stents: Recommendations Class I 1. Before implantation of DES, the interventional car- diologist should discuss with the patient the need for and duration of DAPT and the ability of the patient to comply with and tolerate DAPT.212 (Level of Evidence: C) 2. DES are useful as an alternative to BMS to reduce the risk of restenosis in cases in which the risk of restenosis is increased and the patient is likely to be able to tolerate and comply with prolonged DAPT (Level of Evidence: A for elective PCI453,453a,454 456; Level of Evidence: C for UA/NSTEMI453; Level of Evidence: A for STEMI453,456 459). 3. Balloon angioplasty or BMS should be used in patients with high bleeding risk, inability to com- ply with 12 months of DAPT, or anticipated invasive or surgical procedures within the next 12 months, during which time DAPT may be inter- rupted.208,460 462 (Level of Evidence: B) Class III: HARM 1. PCI with coronary stenting should not be performed if the patient is not likely to be able to tolerate and comply with DAPT.208 211 (Level of Evidence: B) 2. 