Case Report: Recurrent spontaneous coronary artery dissection involving the left main

Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute coronary syndrome, particularly in previously healthy women under 60 years of age. Despite growing awareness, SCAD remains difficult to diagnose and treat because of its variable presentation and the risk of recurrence. This report aims to illustrate the complexity of recurrent SCAD (R-SCAD), particularly when it occurs in the peripartum period and involves the left main (LM) coronary artery, and to highlight the importance of a personalised, multidisciplinary approach. A 47-year-old woman presented with R-SCAD. Her first episode occurred four years earlier, two months postpartum, when she was admitted with an anterior ST-elevation myocardial infarction (STEMI). Coronary angiography showed SCAD of the mid left anterior descending artery (LAD). A percutaneous coronary intervention (PCI) was attempted, including stent placement in the LAD; however, the procedure failed because the true lumen of the LAD could not be identified, and an iatrogenic dissection of the LAD ostium was observed. The patient underwent emergency coronary artery bypass grafting (CABG). Four years later, she was readmitted due to inferior STEMI. Angiography revealed R-SCAD of the LM and LAD, with additional involvement of the left circumflex artery (LCx). Optical coherence tomography (OCT)-guided PCI of the LM and LAD was performed. The patient was discharged in stable condition, with plans for long-term follow-up and testing for possible underlying disease. This case highlights the recurrent and challenging nature of SCAD, especially when it presents with peri- and postpartum onset and involves the LM. The clinical significance of this paper is that it emphasises the need for tailored management, careful evaluation of invasive procedures, the adoption of advanced interventional techniques and imaging, and multidisciplinary follow-up. R-SCAD should prompt evaluation for systemic arteriopathies or connective tissue disorders. Recognising these complexities is vital to improving outcomes and preventing future cardiovascular events.