We describe a case of dissection of the coronary ostium and sinus of Valsalva during a recanalization procedure to address chronic total occlusion of the right coronary artery (RCA). The patient was treated conservatively, and 1 month later, underwent angioplasty of the RCA and marginal branch. Based on a review of the incidence of, management strategies for, and causes of dissection of the RCA and ascending aorta, we conclude that the frequency of this condition may be underestimated and, in view of the increasing number of elderly patients, will rise over time.