Spontaneous coronary artery dissection (SCAD) should be strongly suspected in young women with few or no traditional risk factors for atherosclerosis. Prompt diagnosis and treatment improve survival. The most appropriate strategy for managing SCAD is still controversial due to the heterogeneity of this population. We describe a case of spontaneous left main coronary artery (LMCA) dissection in a young women that was successfully managed by percutaneous coronary intervention (PCI) followed by coronary artery bypass grafting (CABG), this case illustrates the utility of coronary computed tomography (CT) and magnetic resonance imagery (MRI) in assessing complex coronary dissection, thereby helping to determine the best timing for surgery.