Coronary perforation with rotablator atherectomy occurs very rarely. Most often, this leads to communication of the coronary artery to the pericardial space. Perforation of a coronary artery into an anatomic cavity chamber is the rarest type of perforation. Most patients with isolated small coronary artery fistulas are asymptomatic. Small coronary artery fistulas closed spontaneously in most of the cases. We report a case where rotablator atherectomy caused a coronary artery rupture and fistulization to the right ventricle with spontaneous occlusion in a following coronary angiogram.