How should I treat an extended spontaneous coronary artery dissection in a young woman without cardiovascular risk factors mimicking Takotsubo cardiomyopathy?

BACKGROUND: The ideal treatment of spontaneous coro nary artery dissection (SCAD) is still controversial. INVESTIGATION: A young 39-year-old woman without cardiovascular risk factors presented with acute chest pain, following a quarrel. The admission electrocardiogram showed mild ST-elevation in V2-V3 anterior leads. Echocardiography revealed left ventricular apical dyskinesis, mimicking Takotsubo cardiomyopathy. DIAGNOSIS: Coronary angiography showed SCAD extending from the mid to distal left anterior descending (LAD) coronary artery, confirmed by intravascular ultrasound (IVUS). MANAGEMENT: After predilation, three BVS were implanted with partial overlapping. Diagnosis of Takotsubo was ruled out in the presence of SCAD.