ankur kalra , avin aggarwal , rachel kneeland , and jay h. traverse declare no conflict of interest . informed consent was obtained from the patient for publication of this case report and associated images . this article is distributed under the terms of the creative commons attribution noncommercial license which permits any noncommercial use , distribution , and reproduction in any medium , provided the original author(s ) and the source are credited .
spontaneous coronary artery dissection ( scad ) is a rare , life - threatening condition that usually manifests as an acute myocardial infarction . diagnosing scad with conventional coronary angiogram can be challenging , particularly if the true lumen is severely narrowed . 
 our case highlights the challenges in performing successful percutaneous coronary intervention ( pci ) in patients with scad . 
 intravascular ultrasound can prove to be a pivotal tool in the diagnosis and successful management of such cases by establishing the anatomic site of dissection , and confirming stent placement in the true lumen following pci.electronic supplementary materialthe online version of this article ( doi:10.1007/s40119 - 014 - 0029 - 4 ) contains supplementary material , which is available to authorized users .