Giant coronary aneurysm thrombosis leading to acute myocardial infarction: case report

Coronary artery aneurysm (CAA) is defined as a localized irreversible dilation of the coronary vascular lumen with a diameter ≥ 1.5 times that of the adjacent normal coronary segment. AXP, male, 65 years old, had acute coranary syndrome and was sent to coronary unit. After 24 hours, he underwent coronary angiography that showed giant aneurysm with thrombus and total occlusion at the origin of the right coronary artery. There was an aneurysm in the left main and aneurysms in the proximal thirds of the left anterior descending artery (LAD) and left circumflex artery, and mild stenose in the LAD. This case was debated by Heart Team and was decided to refer the patient to surgery. One week latter the procedure was done and this patient was discharged on 4th after surgery. Which treatment modality (clinical, percutaneous or surgical) should be chosen for giant CAAs depends on aneurysm factors such as size, location, speed of growth and others, as well as patient factors, hospital structure, multidisciplinary team experience, etc. There are no recommendations based on guidelines for the treatment of coronary aneurysms, so the management should be individualized and according to Heart Team.