The need for emergency CABG has dramatically decreased with advances in PCI technology, particularly coronary stents.243,244 Recently the NCDR reported the rate of emer- gency CABG at 0.4%.244 Procedure-related indications for CABG in 1 large series included coronary dissection (27%), acute artery closure (16%), perforation (8%), and failure to cross the lesion (8%).245 The strongest predictors of the need for emergency CABG in several analyses are cardiogenic shock (OR: 11.4), acute MI or emergency PCI (OR: 3.2 to 3.8), multivessel disease (OR: 2.3 to 2.4), and type C lesion (OR: 2.6).243,245 In-hospital mortality for emergency CABG ranges from 7.8% to 14%.243,245,246 In a contemporary analysis from the NCDR, the incidence of PCI-related stroke was 0.22%.247 In-hospital mortality in patients with PCI-related stroke is 25% to 30%.247,248 Factors associated with an increased risk of stroke include fibrinolytic therapy administered before PCI (OR: 4.7), known cerebro- vascular disease (OR: 2.20), STEMI as the indication for PCI (OR: 3.2), use of an intra-aortic balloon pump (IABP) (OR: 2.6), older age (OR: 1.17 per 5-year increase), and female sex.247 249 Initial imaging after a stroke in 1 small series revealed hemorrhagic etiology in 18%, ischemic etiology in 58%, and no clear etiology in 24%.248 One potential algo- rithm for the treatment of catheterization-related stroke has been recently proposed.250 This document includes no spe- cific recommendations for the management of PCI-related stroke but refers the reader to the AHA/American Stroke Association guidelines for the management of adults with Vascular complications from PCI are primarily related to vascular access. Important femoral vascular complications include access site hematoma, retroperitoneal hematoma, pseudoaneurysm, arteriovenous fistula, and arterial dissection and/or occlusion.252 The incidence of these vascular compli- cations in various reports generally ranges from 2% to 6% and has decreased with time.249,253 257 Factors associated with an increased risk of vascular complication include age 70 years, body surface area 1.6 m2 , emergency procedures, peripheral artery disease, periprocedural use of glycoprotein (GP) IIb/IIIa inhibitors, and female sex (if not corrected for body surface area).249,253,254,257,258 Ultrasound guidance has been used for femoral artery access to potentially decrease complications.259 As discussed in Section 5.11, vascular closure devices have not been clearly demonstrated to decrease vascular complication rates. 