Coronary stenting after failure of conservative treatment for spontaneous coronary dissection: Usefulness of the intravascular ultrasound

Spontaneous coronary dissection of a coronary artery is a rare cause of acute coronary syndrome. Optimal treatment has not yet been established. We describe a woman with spontaneous dissection of the left anterior descending artery who presented transitory angina and electrocardiographic ST segment elevation in precordial leads. Conservative treatment was carried out. The angina and electrocardiographic changes recurred 3 days later. An intravascular vascular ultrasound was performed and the patient was stabilized following stenting. Stress testing was negative at 6-month follow-up and she remained asymptomatic at 18 months. We discuss the usefulness of an intravascular ultrasound study to establish the therapeutic strategy.