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A 62 year old woman with a history of hypertension and atypical chest pain was referred for coronary angiography following an abnormal exercise treadmill stress test. Coronary angiography showed separate ostium of the left anterior descending (LAD) and left circumflex arteries and apparent stenosis of the ostial portion of the LAD. Intravascular ultrasound (IVUS) imaging (Galaxy II, Boston Scientific Corp, Natick, Massachusetts, USA) showed an oval orifice of the LAD measuring 9 mm2 in cross sectional area with no atherosclerosis. IVUS assessment of the LAD in the setting of separate ostium can be useful to exclude significant atherosclerosis.