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Electrocardiograms performed at the originating hospital. (A) ECG performed on admission due to upper abdominal pain. (B) ECG performed during the ED visit due to left-sided chest pain.
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An electrocardiogram (ECG) revealed serious ST-segment elevations in the II, III, aVF and V2-V6 leads (Fig. 1A) compared to the ECG from his initial admission (Fig. 1B).
Approximately 99% stenosis of the proximal-left anterior descending coronary artery as revealed by coronary angiography.
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CAG revealed 99% stenosis of his distal-left anterior descending coronary artery (LAD, Fig. 2).
Intravascular ultrasound images before percutaneous coronary intervention. (A) The proximal region of spontaneous coronary artery dissection (SCAD). (B) The middle region of SCAD. (C) The distal region of SCAD.
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Intravascular ultrasound (IVUS) revealed dissection of the media tunica and a hematoma pressing on the true lumen (Fig. 3); thus, SCAD in the lesion was confirmed.
Intravascular ultrasound images after percutaneous coronary intervention. (A) The proximal region of spontaneous coronary artery dissection (SCAD). (B) The middle region of SCAD. (C) The distal region of SCAD.
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STEMI due to SCAD in the LAD. Subsequently, sequential balloon expansions were performed, and the lesion was successfully stented (PROMUS Premier  2.5x38 mm; Fig. 4, IVUS images).
Superior mesenteric artery dissection as revealed by contrast-enhanced computed tomography. (A) Transverse plane. (B) Sagittal plane.
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The diameter was 10 mm, and the length was 80 mm (Fig. 5).