Case Report Spontaneous Coronary Artery Dissection/Intramural Haematoma in Young Women with ST-Elevation Myocardial Infarction: (It Is Not Always a Plaque Rupture Event) George Kassimis, 1 Athanasios Manolis, 1 and Jonathan N. Townend 2 1 Department of Cardiology, Asklepeion General Hospital, Athens, Greece 2 Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK Correspondence should be addressed to George Kassimis; gksup@yahoo.gr Received 31 July 2015; Revised 8 October 2015; Accepted 8 October 2015 Academic Editor: Man-Hong Jim Copyright © 2015 George Kassimis et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Spontaneous coronary artery dissection (SCAD) is an unusual, but increasingly recognized, cause of ST-elevation myocardial infarction (STEMI), especially among younger patients without conventional risk factors for coronary artery disease (CAD). Although dissection of the coronary intima or media is a hallmark fnding, hematoma formation within the vessel wall is ofen present. It remains unclear whether dissection or hematoma is the primary event, but both may cause luminal stenosis and occlusion. Te diagnosis of SCAD is made principally with invasive coronary angiography, although adjunctive intracoronary imaging modalities may increase the diagnostic yield. In STEMI patients, the decision whether to pursue primary percutaneous coronary intervention (PCI) or appropriate conservative medical therapy is based on clinical presentation, the extent of the dissection, the critical anatomy involvement, and the amount of ischaemic myocardium at risk. In this case report, we present two cases of young women with SCAD and STEMI, successfully treated with primary PCI. We briefy illustrate the characteristic aspects of the angiographic presentation and intravascular ultrasound-guided treatment. SCAD should always be considered in young STEMI patients without conventional risk factors for CAD with primary angioplasty to be required in patients with ongoing myocardial ischemia. 1. Introduction We present two cases of young women with spontaneous coronary artery dissection (SCAD) and ST-elevation myocar- dial infarction (STEMI) successfully treated with primary percutaneous coronary intervention (PCI). 2. Case 1 A 50-year-old postmenopausal woman with no cardiovascu- lar risk factors was admitted with an anterior STEMI. Te coronary angiogram (CA) demonstrated the right coronary artery (RCA) dominant and normal (Figure 1(a)); the lef main stem and circumfex vessels all appeared normal, but there was a very unusual appearance in the mid lef anterior descendent (LAD), of an almost subtotally occluded long tubular segment of LAD disease afer a large diagonal branch (Figure 1(b)) with TIMI 2 coronary fow, which did not respond to 200 micrograms of intracoronary nitroglycerine. Tere was a strong suspicion that this was an intramural haematoma (IH), rather than a plaque rupture event, and afer predilatation with a 2/20 mm balloon at 8 atm, we performed intravascular ultrasound (IVUS) imaging. Tis clearly demonstrated that proximally and distally to the abnormal fndings the vessel was entirely normal with no evi- dence of atheroma. However, there was a very long segment of about 70–80 mm in length of IH, which was compressing the true lumen (Figures 1(c) and 1(d)). Afer further predi- latation with a 2.5/20 mm balloon at 10 atm and further 200 micrograms of intracoronary nitrate the fow picked up and the ST segments then settled and the patient became pain- free (Figure 1(e)). We electively did not stent the LAD due to Hindawi Publishing Corporation Case Reports in Cardiology Volume 2015, Article ID 597234, 5 pages http://dx.doi.org/10.1155/2015/597234