Cardiac catheterization laboratories are experiencing phenomenal change, as their volume increases and cases become more complex. In the search for the perfect angiographic result, interventional cardiologists have explored numerous therapeutic complementary devices that are used in the cath labs to facilitate achieving this elusive prize. Unfortunately, these adjunctive interventional devices are lacking in the majority of cath labs all around developing countries including those in Middle East /North Africa region (MENA region). In fact, most of coronary interventions here became restricted to implantation of bare metal stents or drug-eluted stents with or without simple balloon predilatation or post-dilatation. Thelimited adoption of complementary devices reflects concerns of the high costs for these devices, un-suitability for their re-sterilization, having their own learning curve with compelling continuous need for high level oftraining. In this review, we will summarize the evidence base concerningmost of the important therapeutic complementary cardio-vascular interventional devices and comment on challenges facing the more widespreadadoption of their use in MENA region .Hopefully, this objective analysis would help fostering their further growth and penetration into the markets, making them part of daily practice.