Giant Coronary Artery Aneurysm Arising From a Septal Perforator

OBJECTIVE: Coronary artery aneurysms (CAAs) are rare, and management is often uncertain. We present a case of a massive CAA arising from a large septal perforator branch of the left anterior descending coronary artery that was treated successfully with coiling with complete obliteration of the aneurysmal cavity. KEY STEPS: The coiling strategy was 2-fold: intrasaccular coiling to promote thrombosis of the aneurysmal cavity and coil embolization of the feeding septal perforator branch to eliminate residual flow. Angiography confirmed complete occlusion of flow to the aneurysm and the septal branch. Regression in aneurysm size was appreciated on follow-up computed tomography. POTENTIAL PITFALLS: Coiling CAAs may result in incomplete occlusion, coil migration/embolization, conduction disturbances, mechanical injury (vessel dissection or perforation), aneurysm rupture, and ischemia or myocardial infarction. Long-term outcome data are scarce in the literature. TAKE-HOME MESSAGES: When anatomy permits, transcatheter coiling via a feeding branch can fully obliterate a giant septal CAA and represents a viable alternative to surgical approaches. Multimodality imaging is essential for diagnosis, procedural planning, and postprocedural assessment.