Background: A 61-year-old woman presented with one week of shortness of breath and was found to have occluded proximal right coronary artery with left to right collaterals. After predilation optical coherence tomography (OCT) imaging and power contrast injection was done to guide stenting therapy. Investigation: Diagnostic angiography with bilateral injection of contrast injection, OCT, intravascular ultrasound of the aorta and MSCT. Diagnosis: Iatrogenic right coronary artery and aortic dissection. Treatment: Stenting of the right coronary artery and its ostium with covered stent and drug eluting stents; imaging with OCT post stenting; imaging of the aorta with peripheral IVUS and MSCT.