Distal wire perforation is an infrequent percutaneous coronary intervention (PCI) complication, which may progress to one of the fearful conditions, cardiac tamponade, and rarely to iatrogenic pericarditis. We described 2 cases of acute pericarditis and cardiac tamponade following distal guidewire coronary artery perforation that was successfully managed with pericardiocentesis, anti-inflammatory agents, and meticulous follow-up. Although uncommon, acute traumatic pericarditis may also be considered as a complication after a complex PCI.