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Optical coherence tomography for strategy planning and staged optimization of spontaneous coronary artery dissection.

A 49-year-old non-pregnant female, taking no hor-monal replacement therapy, smoker, and with a family history of myocardial infarction, was admit-ted with inferior ST-segment elevation myocardial infarction. Angiography of the right coronary artery demonstrated a diffuse tubular narrowing in the proximal segment ( A ). A spontaneous coronary artery dissection (SCAD), type 2A, was suspected. Optical coherence tomography (OCT) demonstrated a large dissection, with the presence of a false double lumen and an associated diffuse circu-lar haematoma, resulting in the compression of the true lumen ( B – C – D ). Because of ongoing ischaemia (ST-elevation and severe chest pain), the decision to stent the dissection to