S pontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndromes but is represented disproportionately in young female patients. No specific guidelines exist concerning the appropriate treatment (medical therapy, intracoronary stents, coronary bypass surgery) or the optimal type of stents in otherwise atheroma-free vessels. The role of intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has yet to be fully established. A large crescent-shaped eccentric hematoma (*). IVUS showed well the inner lumen (thick arrow) and external vessel reference (thin arrow); OCT showed the hematoma compression and demonstrated the integrity of an otherwise disease-free intima but did not reveal the vessel reference diameter as clearly as IVUS. D, Normal proximal LAD. OCT measurement of reference lumen area and diameter for stent sizing are shown.
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