Patients with HBR pose a significant challenge to PCI due to the often pro-hemorrhagic nature of the procedure and post-procedural interventions. Managing coronary artery disease (CAD) in patients with high-bleeding-risk (HBR) patients presents a significant challenge due to the often pro-hemorrhagic nature of the procedure and post-procedural interventions. Frequently, HBR patients are deemed ineligible for coronary artery bypass graft (CABG) and therefore need PCI with drug-eluting stents. However, this therapeutic approach requires dual antiplatelet therapy (DAPT), inevitably increasing the risk of bleeding. When the patient factor of HBR is compounded with complicated heart disease or lesions characterized by increased PCI complexity, the clinical scenario transitions to that of CHIP. Most of the evidence regarding the use of protected PCI in HBR patients must be extrapolated either from studies that reported bleeding complications in patients undergoing protected PCI or from studies conducted in HBR patients undergoing unprotected PCI. There are several strategies that can be implemented to reduce bleeding risk in patients undergoing protected PCI with mechanical circulatory support.