Presented is a 76-year-old female with history of coronary artery disease and post-cardiac bypass surgery 20 years ago. She has chronic atrial fibrillation with severe left ventricular dysfunction and implantable cardiac defibrillator. She was referred for diagnostic coronary angiography due to dyspnea on exertion. Coronary angiography demonstrated occluded left anterior descending and circumflex arteries in the mid third; the right coronary artery was occluded in the ostium. The saphenous vein graft (SVG) to the left anterior descending artery is occluded. The SVG to the right coronary artery is patent with a very large aneurysm in the proximal portion ( Fig. 1 ). The 256-slice computed tomography displayed an aneurysm (maximum diameter 5.8×4.5 cm) of the proximal third of the SVG to the right coronary artery ( Fig. 2 ). After engaging the SVG with a 125-cm Judkins Right 6F coronary guide, the aneurysm was crossed with a 0.014-in. Luge coronary guide wire (Boston Scientific). The Judkins Right guide was retrieved and an 8F 90-cm Flexor shuttle sheath (COOK) was advanced to the ostium of the SVG. The coronary guide wire was exchanged over Quick-Cross support catheter (Spectranetics) to a 0.035-in. Supra Core guide wire. A polytetrafluoroethylene self-expandable covered stent 7/50 mm VIABAHN (GORE) was deployed and a balloon 7/40 mm was inflated at high pressure in the proximal and distal end sealing the aneurysm ( Fig. 3 ). The post-procedure course was uneventful and the patient was discharged on dual antiplatelet therapy and warfarin. Coronary artery aneurysms have been defined as localized coronary dilations with diameters at least 1.5 times the diameters of adjacent normal coronary segments.
