Isolated bilateral coronary ostial stenosis, a rare presentation of coronary artery disease

Coronary ostial stenosis is a rare manifestation of coronary artery disease (CAD). Bilateral ostial stenosis is uncommon, especially in the absence of further coronary sclerosis or stenosis in subsequent vessels. A 77-year-old female was transferred for coronary angiography due to non-ST-elevation myocardial infarction (NSTEMI) following elective total knee replacement. She reported thoracic pressure and dyspnea after the surgery. Coronary angiography revealed isolated bilateral coronary ostial stenosis with no change after intracoronary nitroglycerin administration. A Vasospastic etiology was excluded via staged coronary computed tomography (CT). The patient underwent successful coronary artery bypass grafting (CABG) and was discharged nine days after cardiac surgery. Isolated bilateral coronary ostial stenosis has been associated with autoimmune diseases, surgical interventions and infections. However, in this case, none of the known causes were identified. Although rare, isolated bilateral coronary artery stenosis should be considered as a high-risk presentation of CAD requiring thorough diagnostic work-up and individualized treatment planning.