We discuss a case of SCAD (spontaneous coronary artery dissection) that resulted in a STEMI. We go over PCI techniques for SCAD, which are often opposite for what we normally do for PCI. We also review the mechanism for SCAD formation as well as strategies for medical management and SCAD prevention. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital