Abstract: Percutaneous coronary intervention (PCI) is a feasible strategy for vascular remodeling in high-risk coronary artery disease patients who are not suitable for surgery or refuse surgery. However, such high-risk patients are at higher risk of hemodynamic collapse during balloon inflating or complex procedures, especially when coronary artery dissection with vessel closure or without re-flow occurs. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been introduced as a temporary mechanical circulatory support (MCS)for high-risk PCI, which can provide adequate systemic perfusion during surgery. This article reviewed the studies on the preventive use of extra-corporeal membrane oxygenation (ECMO) in technically complex high-risk PCI without obvious shock.