Salvage angioplasty and stenting following spontaneous dissection of the left anterior descending coronary artery.

A 46 year old woman presented with sudden onset severe, tight, central chest pain. She had stopped smoking 10 years previously, but there were no other cardiac risk factors. The ECG showed sinus rhythm with marked ST elevation over the anterior chest leads, and she received intravenous tPA within two hours of symptom onset. Despite thrombolysis, diamorphine, and intravenous â blockade, the pain persisted. The ECG showed increased ST elevation. She was transferred to the regional cardiac centre where examination revealed persistent severe chest pain, tachycardia, and hypotension. Coronary angiography showed an occlusive dissection flap in the proximal left anterior descending coronary artery (fig 1A); circumflex and right coronaries were normal. Balloon