GIANT CORONARY ARTERY ANEURYSMS MANAGED WITHOUT SURGERY: A CASE FOR CONSERVATIVE MANAGEMENT

<p style="text-align: justify;"><span class="a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none">Giant coronary artery aneurysms are a rare and potentially life-threatening subset of coronary artery anomalies. They are most frequently detected incidentally and can pose significant management challenges due to their unclear natural history and risk of complications. Although aneurysm size often raises concern, current evidence does not uniformly support surgical intervention in all cases. We present the case of a 66-year-old asymptomatic male initially admitted for endovascular treatment of a 72 mm abdominal aortic aneurysm (AAA). Preoperative multidetector computed tomography (MDCT) angiography unexpectedly revealed two giant coronary artery aneurysms: a 75 mm aneurysm in the left anterior descending (LAD) artery and a 48 mm aneurysm in the right coronary artery (RCA). Coronary angiography showed no obstructive coronary artery disease or distal perfusion impairment. Given the absence of symptoms, preserved flow, and high surgical risk, the institutional Aortic Board opted for conservative management. Endovascular aneurysm repair (EVAR) was successfully performed for the AAA. At 12-month follow-up, the patient remained clinically stable, with no progression of coronary aneurysm size or endoleak. This case highlights the importance of individualized decision-making in patients with incidentally detected giant coronary artery aneurysms. In the absence of high-risk features, conservative management with close follow-up may be a safe and effective approach, even in cases with extremely large aneurysms.</span></p>