Cerrato E, Pavani M, Barbero U, et al. - Since Ellis grade III coronary artery perforations (G3-CAP) continues to be a life-threatening complication of percutaneous coronary intervention (PCI), with high morbidity as well as mortality and absence of consensus concerning optimal management strategies, therefore, researchers performed this review of all PCIs conducted in 10 European centers from 1993 to 2019, documenting all G3-CAP as well as treatment strategies, in-hospital and long-term result based on Device-related perforations (DP) and Guidewire-related perforations (WP). The overall sealing success rate was estimated to be 90.7% and generally needed multiple maneuvers (80.4%). To achieve hemostasis, the most frequently employed strategies in the DP group were prolonged balloon inflation (73.2%) with covered stent implantation (64.4%) and in the WP group were prolonged balloon inflation (53.8%) with coil embolization (41%). Overall, although rare and despite improved rates of adequate perforation sealing G3-CAP resulted in significant adverse events. Different patterns of G3-CAP resulted from DP and WP and treatment strategies are advised to be based on this classification.