Superior vena cava (SVC) syndrome is a clinical condition characterized by impaired venous return from the upper body due to intrinsic or extrinsic obstruction of the SVC. Endovascular stenting has become an effective intervention for symptomatic relief. However, the procedure carries a rare risk of life-threatening complications, including SVC perforation and cardiac tamponade. This study describes a 60-year-old male with SVC syndrome secondary to squamous cell carcinoma of the lung who developed SVC perforation and cardiac tamponade during endovascular stenting. Despite initial hemodynamic compromise and cardiac arrest, prompt intervention with pericardiocentesis, aggressive resuscitation, and deployment of a covered stent resulted in a successful outcome within 4 minutes. This report highlights the critical role of anesthetic management in SVC syndrome cases, emphasizing the importance of airway precautions, hemodynamic stability, and access to inferior venous return for large-volume resuscitation. This case underscores the need for vigilance in recognizing and managing SVC stenting complications. Furthermore, it advocates for a multidisciplinary approach involving anesthesiology, interventional radiology, and cardiothoracic surgery to optimize outcomes.