Spontaneous dissection of left main coronary artery associated with hypertensive crisis: a probable fatal complication detected by intravascular ultrasound.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute ischemic coronary events with complex pathophysiology. It usually occurs in middle-aged women during pregnancy and postpartum period without traditional risk factors for coronary artery disease (CAD). Those patients over age 40 are more likely to have dissections associated with atherosclerosis. Several drugs and clinical conditions are associated with SCAD. It is frequently fatal and a great number of cases have been diagnosed at necroscopy. The quick recognition of SCAD and initiation of treatment may be life saving. In this report, we define a case of dissection of left main coronary artery, possibly triggered by hypertensive crisis, with no apparent atherosclerotic involvement detected by intravascular ultrasound (IVUS) and successfully treated with surgical revascularization.