Percutaneous coronary intervention (PCI) is considered as the standard treatment of obstructive coronary artery disease in indicated patients. Even though PCI gives symptomatic angina improvement, but associated with serious complications like coronary artery perforation (CAP), the incidence is quite low. With the more complex lesions for successful angioplasty, different devices are required, which in turn increase the incidence of CAP in these patients. Here we review the classification, incidence, pathogenesis, clinical sequela, risk factors, predictors, and management of CAP in the current era due to PCI.