Aim: To report a case of coronary artery perforation (CAP) with cardiac tamponade, treated by a trauma surgeon in a hospital without an extracorporeal circulation device. Background: Percutaneous coronary interventions (PCIs) are ordinarily performed worldwide. One rare complication is vessel perforation, occurring in approximately 0.1–0.5% of all interventions. Most descriptions are reported in facilities with access to extracorporeal circulation. Case description: A 51-year-old man underwent an angioplasty with stent placement in the right proximal coronary artery. At the end of the procedure, a leak in the vessel was identified, with contrast extravasating into the pericardial space. The patient began to complain of progressing dyspnea and presented with cold extremities, jugular venous distension, and tachycardia. Immediately after the leak was identified, his blood pressure was 130/80 mm Hg, which fell to 88/60 mm Hg 15 minutes later. Point-of-care ultrasonography confirmed the pericardial effusion, and it was decided to approach the pericardium through a left anterolateral thoracotomy. The coronary artery showed no active bleeding, all blood was evacuated, and the pleural cavity was drained. On the 3rd postoperative day, pneumonia was identified, which was treated without complications. He was discharged on the 5th postoperative day. On the 40th postoperative day, he had no complaints, and his echocardiography revealed no abnormalities related to the procedure. Conclusion: The diagnosis and treatment of CAP with cardiac tamponade must be swift. The surgical approach initially aims to alleviate the tamponade; subsequently, the situation must be evaluated regarding the necessity to address the perforated vessel. Clinical significance: Cardiac trauma is a rare event, and coronary artery trauma is even rarer. Iatrogenic cardiac trauma is increasing due to percutaneous intervention. In the absence of an extracorporeal circulation device, the trauma surgeon must choose a surgical approach that allows for the alleviation of tamponade, is swift, and provides access to the potential bleeding site. Rapid and assertive decisions are more complex than the surgical technique itself.