Case report: a clinical case of a giant coronary artery aneurysm treated by percutaneous exclusion.

Background: This case report contributes to the limited literature on giant coronary artery aneurysms (CAAs), particularly those arising from secondary coronary branches. It highlights the utility of multimodal imaging in diagnosis and supports endovascular management as a viable treatment option in high-risk patients. Case summary: A middle-aged patient presented with a paracardiac mass incidentally discovered on imaging. Further evaluation revealed a giant aneurysm originating from a secondary branch of the right coronary artery. Given its large size and high rupture risk, the patient underwent successful percutaneous exclusion with a covered stent. Post-procedural recovery was uneventful, and follow-up imaging confirmed aneurysm exclusion without complications. Conclusion: This case emphasizes the importance of individualized treatment planning for giant CAAs and illustrates the effectiveness of percutaneous intervention using covered stents. It also reinforces the role of comprehensive imaging in guiding both diagnosis and management of rare coronary anomalies.