Spontaneous coronary artery dissection evaluated by optical coherence tomography.

A 42-year-old woman underwent coronary angiography for acute coronary syndrome. It showed a progressive narrowing from the middle segment of the left anterior descending artery. Optical coherence tomography (OCT) confirmed the angiographic suspicion of spontaneous coronary dissection. OCT also revealed different patterns of subjacent disease, imperceptible to the angiography: areas of intramural hematoma with blood stasis, progressive compromise of the true lumen, and areas with active flow through the false lumen. It also detected the distal guidewire going out from the true to the false lumen, a feature of capital importance to lead an eventual coronary intervention.