Coronary artery perforation (CAP) is among the most feared complications of percutaneous coronary intervention (PCI), representing a potentially catastrophic event for which both immediate and effective treatment is essential. Although an uncommon event, the incidence of CAP has not declined over time while other PCI-related complications have significantly decreased . Perhaps reflecting the increasing patient and lesion complexity with contemporary PCI, CAP occurred in 4.3 % of patients among patients with complex coronary anatomy who were ineligible for bypass surgery . Development of tamponade that requires pericardiocentesis is commonplace, and emergency surgery may also be necessary . Further, despite its uncommon occurrence, CAP is associated with considerable short- and late-term mortality .