Iatrogenic acute aortic dissection during percutaneous coronary intervention is an extremely rare, but critical complication. Localized aortic dissections have been treated by sealing the entry with a coronary stent. Extensive dissections may require a surgical intervention. We present a case of type A extensive aortic dissection occurring during angioplasty of the left circumflex artery for acute myocardial infarction. This iatrogenic aortic dissection required emergent surgical repair with supracoronary replacement of the ascending aorta.