A coronary artery aneurysm is an enlargement of the coronary artery exceeding 1.5 times the diameter of the adjacent normal segment1. A 29-year-old man presented with retrosternal chest pain and exertional dyspnoea, which had been ongoing for 1 month. A coronary angiogram showed an ectatic left anterior descending artery (LAD) with aneurysmal dilatation of ≈3 cm diameter (Figure 1A, Moving image 1, Moving image 2). A cardiac computed tomography angiogram revealed a large contrast-filled aneurysm measuring 3.5 cm x 3.5 cm x 3.2 cm (Figure 1B), seen predominantly filling in the later arterial/delayed phase communicating with the distal LAD. The aneurysm was burrowed in the right ventricular apical myocardium with mild calcification. The patient underwent coiling of the distal LAD aneurysm with 4 coils (Concerto Helix [Medtronic]: 14 mm x 30 cm, 16 mm x 40 cm, 18 mm x 40 cm, 16 mm x 40 cm) (Figure 1C–Figure 1D–Figure 1E, Moving image 3) and was doing well at 1-year follow-up. Coil embolisation results in occlusion of the aneurysm, formation of organised thrombus, fibrosis, and eventual endothelialisation2. 
Figure 1. Management of giant coronary aneurysm A) The coronary angiogram showed a jet of contrast into a giant coronary aneurysm from the left anterior descending artery (LAD) B) Cardiac computed tomography revealed the presence of a large aneurysm from the LAD burrowed in the apical myocardium of the right ventricle. C) The narrow mouth of the aneurysm was crossed with a balance middle weight (BMW) 0.014” guidewire (Abbott). D) The Progreat microcatheter (Terumo) was advanced into the aneurysm over a BMW 0.014” guidewire. E) Four Concerto detachable coils (Medtronic) were deployed: 3 inside the aneurysm and 1 at the end of the distal LAD. AO: aorta; LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle
Conflict of interest statement
The authors have no conflicts of interest to declare.
