ABSTRACT Coronary artery perforation is a rare but potentially lethal complication of percutaneous coronary intervention, mainly due to hemodynamic compromise secondary to cardiac tamponade development. All interventional cardiologists must thus be able to promptly recognize and solve coronary artery perforation. We describe a successfully and conservatively managed type III coronary artery perforation with prolonged balloon inflations, in the absence of covered stents and without compromising the percutaneous coronary intervention result by anticoagulation reversal.