The Celiac Culprit: Isolated Celiac Artery Stenosis Masquerading as Acute Coronary Syndrome With Marked Troponin...

Marked troponin elevation, indicative of myocardial injury, typically prompts evaluation for acute coronary syndrome (ACS). However, extra-cardiac pathologies can produce identical biomarker patterns, potentially diverting diagnostic reasoning and delaying definitive treatment. Isolated celiac artery stenosis is an uncommon cause of mesenteric ischemia that can mimic ACS. A 78-year-old woman presented with recurrent epigastric pain and significant troponin elevation (peak 2.492 ng/mL) despite non-obstructive coronary arteries. Selective abdominal angiography revealed isolated high-grade celiac artery stenosis with patent superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The lesion was treated with a self-expanding stent, resulting in complete symptom resolution. Four years later, the patient re-presented with identical symptoms and troponin elevation. Imaging demonstrated focal in-stent restenosis, which was successfully treated with a balloon-expandable stent, achieving durable symptom relief. This case illustrates that isolated celiac artery stenosis can closely mimic ACS, producing marked troponin release in the absence of coronary obstruction. Recognition of this masquerading visceral ischemia requires careful attention to symptom patterns and a low threshold for visceral angiography. Durable outcomes can be achieved with endovascular therapy, even in cases of restenosis.