Percutaneous management of coronary aneurysms: case report and evidence base perspective

Coronary artery aneurysms (CAAs) are uncommon but potentially serious findings increasingly detected through advanced coronary imaging. Their etiology is diverse, including atherosclerosis and iatrogenic injury, and their clinical implications range from benign to life-threatening. Treatment strategies vary based on aneurysm size, location, and associated symptoms, and while surgical options have been traditional, percutaneous techniques are gaining ground. We hereby report the case of a patient with an incidentally discovered aneurysm arising from a secondary branch of the proximal right coronary artery. Following heart team evaluation, coil embolization was successfully performed via femoral access using selective wiring and deployment of neurovascular coils, achieving complete exclusion of the aneurysm. We also review the current evidence supporting percutaneous options for CAA management, including covered stents, coils, vascular plugs, liquid embolics, and custom devices. While percutaneous techniques offer promising outcomes with lower procedural morbidity, high-quality comparative data are lacking. Our case highlights the feasibility and safety of coil embolization in anatomically favorable scenarios and supports the need for individualized procedural planning. Broader adoption of these strategies will require systematic data collection and consensus-driven guidelines to optimize long-term outcomes in CAA management.