Giant coronary artery aneurysms: a case series and management recommendations.

Background: Coronary artery aneurysms (CAAs) are a rare clinical entity, and little is known about their natural history, prognosis, and management. Invasive management of patients with CAA is challenging not only because of this limited understanding but also due to the technical challenges associated with both percutaneous and surgical interventions. Case summary: We describe the management of seven cases with giant CAAs in an elective setting. Our first case demonstrates successful percutaneous closure of a giant right coronary aneurysm in an asymptomatic patient using an Amplatzer™ Vascular Plug. In four cases, surgery was performed, due to the presence of symptoms and/or when revascularization by a percutaneous intervention was considered to be unsuitable. Two cases were managed conservatively due to the patients' advanced age and significant comorbidities. Discussion: Although most published cases of giant CAAs involve elective surgical treatment, growing expertise shows that percutaneous intervention is a viable and increasingly promising alternative-particularly in younger patients or those at high surgical risk. Based on the limited available evidence and our own experience, we propose a practical management algorithm to help guide multidisciplinary decision-making. This emphasizes that percutaneous treatment should be actively considered as part of a tailored, patient-specific strategy in the management of giant CAAs.