Coronary artery perforation is a serious complication of percutaneous coronary intervention (PCI). This review summarises the aetiology, incidence, current existing therapeutic options and outcome of coronary perforations given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa). Perforations are classified as Type 1, 2, or 3, as previously defined. Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use and can be initially managed by percutaneous methods.