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Coronary artery perforation is a rare but potentially serious complication of percutaneous coronary intervention (PCI). Clinical manifestation and prognosis of patients depend on the severity of the complication, the occurrence of tamponade, and the methods of treatment. A special type of perforation is caused by damage to the distal segment of the coronary vessel by guidewire. This type of perforation is mostly connected with subacute clinical presentation. The treatment can be difficult, especially when prolonged balloon inflation is no