Excimer laser coronary angioplasty (ELCA) was developed with the aim of improving the outcome of conventional balloon angioplasty [1]; therefore, its original target was limited to a very specific subset of lesions, such as saphenous vein graft, total occlusions, calcified lesions, ostial lesions, lesions greater than 20 mm in length, and balloon dilation failures [2–4]. However, an excimer laser, which can vaporize thrombus, suppress platelet aggregation, and ablate the underlying plaque, has recently been shown to be effective in patients with acute coronary syndrome (ACS) [5]. Although rare, vessel perforation is the most terrible complication of ELCA. Early studies regarding the complications of ELCA in its introductory era revealed that patients with vessel perforation were mainly treated via coronary artery bypass grafting (CABG) [6]; however, the necessity of CABG is decreasing as a result of technological advances, as well as improvements in intervention technique. Therefore, the prognosis of patients who were successfully treated for vessel perforation via ELCA without CABG is not fully addressed. Also, the risk factors related to ELCA-induced vessel perforation in the era of a new indication, ACS, and a new generation excimer laser catheter are unknown.