Role of grey-scale intravascular ultrasound and ChromaFlo in deciding on treatment approach for spontaneous coronary dissection in a young woman.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes. We present the case of a young woman with an acute coronary syndrome caused by SCAD, where grey-scale intravascular ultrasound (IVUS) and ChromaFlo were instrumental in deciding against interventional treatment. The patient’s urgent angiogram gave the impression of a spiral dissection in the right coronary artery. IVUS confirmed the presence of an intimal flap and the ChromaFlo study showed unobstructed flow throughout the dissected segments. No atherosclerotic plaques or intramural hematomas were imaged on the IVUS pullback. In this case, grey-scale IVUS was used to confirm the absence of atherosclerotic coronary artery disease and ChromaFlo to assess flow in the true and the false lumen, excluding the presence of no-flow intramural hematomas. Based on these findings, it was decided to adopt a conservative treatment strategy.