Background Coronary occlusion during type A aortic dissection is a serious complication, associated with high mortality if not identified and treated promptly.

Case Summary We present a case of acute type A aortic dissection, diagnosed with intravascular ultrasound during emergency percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. Emergency PCI was successfully performed as a bridge to definitive central aortic repair surgery.

Discussion This case highlights the integration of multiple diagnostic cardiac imaging modalities in the time-critical evaluation and management of aortic dissection as a cause for ST-elevation myocardial infarction. This case also demonstrates the coordinated multidisciplinary care essential to the initial and long-term management of this life-threatening condition.

Take-Home Messages This case highlights the ability to promptly diagnose acute type A aortic dissection using intravascular ultrasound in patients presenting with acute coronary syndrome. Initial reperfusion with PCI can provide a life-saving bridge to definitive surgical repair.