Clinical Insights Into a Rare Left Main Coronary Artery Aneurysm

This case report presents a 61-year-old female with hypertension and hyperlipidemia who developed giant coronary artery aneurysms (GCAA). Coronary artery aneurysms (CAA) are rare, with GCAA being even rarer, occurring in a very small percentage of CAA cases. The etiology of GCAA remains unclear. While CAAs are often asymptomatic and discovered incidentally, they can lead to severe complications such as myocardial infarction, sudden cardiac death, or rupture. Imaging revealed a significant aneurysm in the coronary bifurcation - initially, the patient presented with atypical chest pain. Patient underwent atypical chest pain workup, including stress test, which was negative. Given the patient's age and comorbidities, the patient underwent a CT angiogram, which revealed a significant aneurysm at the coronary bifurcation into the left anterior descending (LAD) and circumflex arteries. This has been followed over a number of years with serial CT angiograms. A recent CT angiogram reveals a further increase in size of the aneurysm, almost approaching 1 cm. The patient underwent elective coronary angiography, revealing 30% stenosis in the LAD artery and other abnormalities. Given the growing size of the coronary aneurysm, the decision was made to perform surgical repair, including coronary artery bypass grafting. The patient was stabilized in the intensive care unit and was subsequently discharged.