A Tale of Two Evils: Iatrogenic Propagation of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic intimal separation of the coronary arterial wall. While poorly understood, its mechanism confers higher prevalence in younger females, and it is responsible for 25% of acute coronary syndromes (ACS) in women under 50 years of age. SCAD is primarily diagnosed via coronary angiography; however, intraluminal contrast injection and percutaneous coronary interventions (PCI) are associated with an increased risk of propagation and extension of the dissection leading to increased risk of morbidity and mortality. We present the case of a 48-year-old female with multivessel SCAD and subsequent iatrogenic dissection following contrast injection requiring multiple PCI for medical treatment of refractory cardiac angina.