Coronary artery perforations are more likely to occur during percutaneous coronary intervention of complex coronary lesions, such as heavily calcified lesions and chronic total occlusions. Areas covered: Authors provide an update on the management of coronary perforations by performing a critical review of the related, recently published literature. Expert commentary: Meticulous attention to guidewire position and to device selection is critical for minimizing the risk for coronary perforation. If a perforation occurs, following a structured, algorithmic approach can maximize the likelihood of a successful outcome.
Keywords: Perforation; complex coronary interventions; complication; outcomes; percutaneous coronary interventions.