There are caps on each of the perks you can get from the Angel:
| Perk | Cap |
|---|---|
| Max Health Up | 5 |
| Small Attack Up | 4 |
| Small Crit Up | 4 |
| Small Attack Speed Up | 4 |
| Combat Medic | 2 |
| Sisu | 1 |
Once you reach the cap on everything, it keeps offering Small Attack Up, but it doesn’t get taken (won’t show in your perk list, and the text that normally appears when you pick a perk doesn’t)
Of course this can only happen in an Endless (Campaign Endless, Endless Boss or Dark Castle) run, and the first wasted perk will generally be at room 195 - or earlier if you get Max Health Up / Combat Medic from a hidden treasure or perk roll