Abstract: AIM To Investigate clinical features, imaging features, and treatment strategies of spontaneous coronary artery dissection (SCAD). METHODS Clinical data of 11 patients with SCAD in our hospital were analyzed retrospectively, including clinical characteristics, angiographic, and other intracoronary imaging data, treatment and prognosis of these 11 patients combined with past literature, and the etiology, predilection population, imaging features and treatment strategy of SCAD were evaluated. RESULTS All of the 11 patients with SCAD were female. Coronary angiography showed the "rat tail" sign in coronary arteries. Intravenous ultrasound (IVUS) or optical coherence tomography (OCT) was used for diagnosis. Among the 11 patients, 3 underwent percutaneous coronary intervention (PCI), 1 was guided by IVUS, while other 2 patient hematomas spread to the distal vessel causing acute occlusion of the vessel. Other 8 patients were treated conservatively. Prognosis of 11 patients was better and there was no recurrence seen in one-year follow-up. CONCLUSION SCAD is common in middle-aged women and with better prognosis. Intracoronary imaging-guided PCI of SCAD can increase the success rate.