Spurting coronary artery in the pericardial cavity is observed rarely. Pericardial tamponade occurs and myocardial salvaging time starts ticking. Coronary artery perforations (CAP) have been quoted in literature to range from 0.1 % to 0.7 % of percutaneous coronary artery intervention (PCI) cases. Data was collected retrospectively from the patients of Sri Jayadeva Institute of Cardiovascular Sciences and Research in 2012-2019. A total of 2556 PCI were found in our database of which emergency surgical intervention were needed in 4 patients (0.15 %). Decision making in type 3 CAP with hemodynamic instability is highlighted. Although covered stents and balloons are used to stem the leak, importance of an on call cardiac surgeon cannot be exemplified if the situation is not under control.