〔Abstract〕 Objective Coronary perforation (CP) is one of the rare and fatal complications in coronary interventional therapy. To summarize the clinical characteristics, treatment and prognosis of 32 cases of distal and branch perforation of coronary artery treated by percutaneous coronary intervention (PCI) in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2012 to January 2020. Methods Coronary angiography was used to confirm the distal or branch coronary artery perforation, and the patient's age, gender, diagnosis, pathological classification, causes of perforation, perforated vessels and locations, management measures, and intraoperative and perioperative prognosis were recorded and analyzed. Results The mean age of patients was (65 ± 11) years, the proportion of females was 31.3 %, the proportion of patients with unstable angina was 53.1 %, acute myocardial infarction was 46.9 %, and the American Heart Association/American College of Cardiology (AHA/ACC) classification of coronary artery disease was 84.4 %. The rate of chronic total occlusion (CTO) was 46.9 %. Among the reasons for perforation, common working guide wire was 50 %, CTO guide wire 34.4 %, rotary grinding guide wire 3.1 %, compliance balloon 9.4 %, stent balloon 3.1 %, in perforated cases, ELLis type I 9.4 %, type II 43.8 %, type III 46.8 %. The perforation of 59.4 % patients was successfully blocked by closely observation, neutralization of heparin, expansion of balloon compression, etc.; the perforation of 31.3 % patients was successfully blocked by embolization; the perforation of 9.4 % patients required stents or coated stents to seal the coronary artery rupture; 9.4 % patients were complicated with pericardial tamponade; and 66.6 % had postoperative tamponade. The perioperative mortality rate was 9.4 %. Conclusion The incidence of distal segment and branch perforation of PCI is low, it is complicated with pericardial tamponade, and the mortality is high. Early recognition, early detection, active and effective treatment of CP, and adopting various plugging strategies when necessary are the key to successful rescue.