A 78-year-old man was admitted for non ST-segment elevation myocardial infarction. Transthoracic echocardiogram showed normal left ventricular wall kinesis and no significant valvular diseases. Coronary angiography showed a significant three-vessel disease with critical stenoses in ostial left anterior descending artery (LAD), right coronary artery (RCA) from the ostium to the mid portion and of the mid left circumflex artery. After discussion with the patient and evaluation of the Syntax score the decision to proceed with percutaneous revascularization was taken. Ad hoc percutaneous coronary intervention (PCI) of the RCA with implantation of two DES was performed. During PCI a distal posterior descending artery (PDA) guidewire-related Ellis type 2 perforation occurred, and was treated and resolved with 60 second balloon inflation.