Giant coronary aneurysm culprit of an acute coronary syndrome

A 66-year-old male ex-smoker with hypertension, type 2 diabetes mellitus and dyslipidaemia was admitted due to a non-ST segment elevation myocardial infarction. The catheterisation depicted an extensive and calcified disease: chronic total obstruction of the right coronary and severe disease with a giant aneurysm at the first marginal branch as the culprit vessel. After discussion, the right coronary was treated before the circumflex-giant aneurysm was closed with a stent graft and its multiple severe stenosis solved with two drug-eluting stents. We provide a multimodality approach for a complex case and briefly discuss the available options.