55 years old lady with history of multinodular goiter. 
Complained of sudden onset chest discomfort since 8:00 in the morning. no back radiation, pain persistentECG in A&E Department showed  1mm ST elevation over II, III, AVF, with reciprocal depression over AVLEchocardiogram showed mid to apical anteroseptal marked hypokinesia, no aortic flap or aortic regurgitation Haemodynamic was stable and on high side Patient was brought to Cath lab for primary PCI 

coro showed normal RCA, LCx. but LAD noted to have Spontaneously dissection flap along the LAD from proximal to distal LAD with TIMI 1 flow.
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Right radial approach for angiogram which showed long LAD spontaneous coronary dissection We decided to switch to Right femoral approach with 7F shealth and EBU 3.75 SH guiding catheter Difficult in wiring of LAD with SION wire due to extensive dissection flap all along the LADWe tried the straw technique with finecross and try to wire the true lumen with XTA wire but failed after prolonged attempt IV morphine and nitrocine were given SION wire was remained in true lumen, and we used the Terumo short tip IVUS for guidance, finally able to pass the XTA wire to D1 IVUS able pass to D1 and IVUS repeated showed wire in true lumen but large haematoma at pLAD D1 to pLAD  was predilate with 2.0/15 balloon SION and then XTA were used and able to pass to dLAD and confirmed with the short tip IVUS dLAD was stented with 2.25/26 pLAD was treated with 3.0/15 cutting balloon and then stented with 2.75/38 and post dilate with 4.0 NC balloon unable to wire the very distal LAD and procedure stopped due to already 4-5 hour procedure, patient symptom much relieved and haemodynamic stable
However, CK was found serially normal !!Symptom recurred on and off and BP fluctuate CT Aortogram was arranged and confirmed Type A Intramural haematoma and Type B aortic dissection. Patient transferred to CTSU, but conservative treatment adopted in view of recent PCI.Patient recovered well and discharge uneventfully Recent follow up was well and await follow up CT coro and aortogram. 
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A case of double dissection involving coronary and aortic dissection in the same patient. Vascular dissection is a Demon to interventional cardiology. The coronary dissection likely to be a chronic one and we spend on our focus to treat the coronary Demon. But the real Demon is in the aorta, which account for patient's acute event. We need to stay open-minded and think of other possibilities in case of condition change.