A giant left main coronary artery aneurysm

A 67-year old woman with a history of hypertension and atrial fibrillation presented with exertional dyspnea. Her electrocardiogram was consistent with diffuse ST segment depression on the pericardial leads. The patient was referred for coronary angiography, which revealed non-obstructive coronary atherosclerosis and a giant 26x21 mm coronary aneurysm originating from the distal left main system (Fig. A and B, Videos 1 and 2**). The right coronary artery was normal, but had extensive tortuosity. Contrast-enhanced computed tomography (CT) was performed to further define the anatomy and it confirmed the size and origin of the giant left main coronary artery (LMCA) aneurysm (Fig. C and Fig. D). After consultation, the institutional heart team decided that the huge size and proximal localization of the aneurysm precluded percutaneous options, including coil embolization and graft stenting.