Multivessel SCAD involving the left main coronary artery
Spontaneous coronary artery dissection (SCAD) is an infrequent and often misdiagnosis of a non-atherosclerotic cause of acute coronary syndrome (ACS). It is an important cause of ACS in young women, responsible for up to 25% of all cases in women <50 years of age without cardiovascular risk factors.

The present case has been reported in the European Heart Journal Case Reports.

A 42-year-old woman without family history of cardiac disease and neither traditional atherosclerotic risk factors presented to our centre with an anterior acute ST-segment-elevation MI secondary to multiple spontaneous dissections of the left main, anterior descending, and ramus intermedius coronary arteries.

Stenting was performed in the left anterior descending coronary artery and left main coronary artery to resolve its occlusion. Fibromuscular dysplasia was confirmed via computed tomography angiography.

Learning points
• Spontaneous coronary artery dissection (SCAD) is an often misdiagnosed non-atherosclerotic cause of acute coronary syndrome in women presenting with myocardial infarction without traditional cardiovascular risk factors.

• Predisposing factors such connective disorders, autoimmune and inflammatory disorders, and notably fibromuscular dysplasia have all been reported SCAD.

• Intravascular ultrasound or optical coherence tomography can play an important role in the diagnosis of SCAD.

• Treatment remains a challenge and the ideal management strategy has yet to be determined (conservative vs. invasive management).

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