Background: Spontaneous Coronary Artery Dissection (SCAD) is an acute coronary event of uncertain origin. SCAD occurs when the coronary artery wall dissects non-traumatically and non-atherosclerotically, leading to the formation of an intramural hematoma or intimal tear, ultimately compressing and restricting the true lumen, or even occluding it. The management of SCAD remains controversial despite modern imaging techniques. In addition to supportive drug therapy, percutaneous coronary intervention (PCI) is another option that can be used as an effective treatment modality. Case summary: This is a 51-year-old patient with a history of SCAD initially diagnosed in 2019 after presenting with chest pain and anterior ST elevation on ECG. At that time, she was successfully treated by stenting, resulting in symptom resolution. Five years later, she represented with typical cardiac chest pain and ECG suggestive of anterior wall acute myocardial infarction, accompanied by a significant elevation in cardiac enzymes. Intravascular ultrasound (IVUS) revealed a haematoma with SCAD formation extending from the proximal left anterior descending artery (LAD) to the left main stem (LMS). Initial medical management did not suffice, and subsequently percutaneous intervention was required. Discussion: This case report uniquely demonstrates an example of a recurrent SCAD presentation in which short term conservative therapy was not sufficient and subsequent percutaneous intervention was undertaken within hours of initial presentation. Aside from avoiding triggers and optimising hypertension levels, currently there is lack of data for secondary prevention of SCAD.