Recurrent unexpected myocardial infarction in a young woman: Insights on spontaneous coronary artery dissection and multimodality imaging

A 45-year-old female was admitted for a transient anterior ST-segment elevation myocardial infarction (STEMI). Coronary angiogram showed a diffuse severe stenosis of the distal left anterior descending (LAD) coronary artery, which was managed medically. Three years later, a recurrent transient anterior STEMI led to a second coronary angiography showing a tubular stenosis of the mid-LAD with normal distal coronary bed. An optical coherence tomography (OCT) revealed a spontaneous coronary artery dissection (SCAD) with an extensive compressive mural hematoma without any intimal tear. Conservative treatment was continued. A repeat systematic angiogram 3 months later suggested spontaneous healing but the OCT revealed several focal residual hematomas. This case illustrates the different possible angiographic appearances of SCAD and the contribution of the OCT in doubtful situations.