Giant Left Main Coronary Artery Aneurysms Presenting as STEMI

Chura A.C.; Arellano R.B.; Quispe L.F.; Rojas de la Cuba P.; Chacalcaje K.C.; Pachas G.L. · JACC: Case Reports (2025) · DOI: 10.1016/j.jaccas.2025.105760

Resumen

Background: Giant coronary aneurysms are rare and may present with acute myocardial infarction, posing significant diagnostic and therapeutic challenges. Case Summary: We report the case of a 45-year-old woman residing in a high-altitude region who presented with anterior ST-segment elevation myocardial infarction. Initial management included thrombolysis and transfer for rescue angiography, which revealed a giant fusiform aneurysm of the left main coronary artery with thrombotic occlusion of the proximal left anterior descending artery. Additional aneurysms and ectasia were identified in other coronary vessels. Computed tomography confirmed the findings. Surgical resection and revascularization were proposed but were declined by her. She died 6 months later, likely from cardiac causes. Discussion: This case illustrates the importance of multimodality imaging in characterizing giant coronary aneurysms and highlights the complexity of tailoring management strategies in rare, high-risk presentations. Take-Home Message: Multimodality imaging is essential for diagnosis and treatment planning, and management should be individualized through a multidisciplinary approach.