Recurrent spontaneous coronary artery dissection observed with multiple imaging modalities.

Spontaneous coronary artery dissection (SCAD) is considered to be a rare cause of acute coronary syndrome, especially recurrent or multivessel dissection. We present here the case of 51 year-old man who had recurrent and multivessel SCAD. In the initial event, the distal segment of the right coronary artery was spontaneously dissected, which was confirmed by coronary angiography (CAG), intracoronary ultrasound (IVUS), and multidetector computed tomography (MDCT). In the second event, the left coronary artery was spontaneously dissected. The dissection was confirmed by IVUS and MDCT, although CAG did not show stenosis, occlusion, or dissection in the left coronary artery. These findings suggest the weakness of CAG and the usefulness of IVUS or MDCT for the diagnosis of SCAD.