Left main stem spontaneous coronary artery dissection in a cardiogenic shock STEMI patient

Spontaneous coronary artery dissection (SCAD) is a rare, but well recognized cause of ST-elevation myocardial infarction (STEMI), especially in middle-aged women with few or no traditional cardiovascular risk factors. Left main stem (LMS) is the culprit coronary artery in around 13 % of STEMI-SCAD patients, and most of these patients develop cardiogenic shock (CS). LMS-SCAD represents a challenging clinical scenario where both successful revascularisation and haemodynamic support are required. Primary percutaneous coronary intervention (PPCI) in LMS-SCAD is a complex procedure, considering the risk of dissection propagation towards the left anterior descending and/or circumflex coronary arteries and in case it cannot be successfully performed, bailout emergent coronary artery bypass grafting may be needed. We herein present the case of a woman with LMS-SCAD who presented with STEMI and CS, illustrating the characteristic angiographic presentation, the treatment with a successful PPCI and the 6-month follow-up with a computed tomography coronary angiogram.