Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization

In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate ofrevascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult tonegotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication ofcoronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic totalocclusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronaryperforation with tamponade, and successfully managed by coil embolization