Percutaneous coronary intervention has become a fundamental diagnostic and treatment strategy in coronary artery disease. Much like any procedure, it is not without risk; in fact, a rare but life-threatening complication as a result of percutaneous coronary intervention is coronary artery perforations (CAP). The risk of CAPs correspondingly rises in relation to the difficulty of the procedure, location of lesion, and complexity of anatomy. It follows then that early recognition and instigation of an appropriate treatment strategy is key in reducing the mortality and morbidity associated with CAPs. The authors present eight case reports of varying difficulties, their analogous management, and a literature review of management approaches in treating CAPs in order to provide a review of management strategies and to highlight the importance of immediate recognition of a potentially fatal complication.