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Background Left main coronary artery (LMCA) atherosclerosis is a high-risk disease but its occurrence is often underestimated by coronary angiography.Possible explanations for the limitation of plaque detection by angiography include compensatory vessel enlargement in face of intracoronary plaque formation, the lack of reference segments in diffuse atherosclerosis as well as technical limitations.Intravascular ultrasound (IVUS) has been shown to be more accurate and sensitive than coronary angiography in identifying coronary atherosclerotic lesions.We retrospectively analyzed the incidence of left main artery atherosclerosis in angiographically normal patients and the clinical character of these patients.