Detailed Visualization of the Dissected False Lumen Using Intravascular Ultrasound, Optical Coherence Tomography, and Angioscopy in a Young Man With Acute Myocardial Infarction Caused by Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare but critical cause of acute myocardial infarction (AMI). Diagnosing SCAD solely based on angiographic findings is often challenging; therefore, intravascular imaging modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are often required. Angioscopy allows for direct visualization of the vascular lumen, enabling detailed assessment. Herein, we present a unique case of a young man who presented with AMI. Coronary angiography (CAG) revealed diffuse stenosis in the first septal branch; therefore, IVUS, OCT, and angioscopy were performed to obtain images with unprecedented details to evaluate the dissected cavity. Consequently, SCAD was confirmed owing to the identification of a dissected false lumen and a medial layer disruption. Mild atherosclerotic lesions were observed on coronary angioscopy. SCAD has traditionally been considered unrelated to atherosclerosis; however, our findings may indicate a potential pathophysiological link. This comprehensive imaging approach highlights the potential to improve the understanding of SCAD. This is the first case in which the dissection entry of SCAD was observed in detail using angiography.