Saccular aneurysm of the left main trunk
Aneurysms of the left main coronary artery are substantially rare, being found in approximately 0.1% of patients undergoing coronary angiography.1 They are usually atherosclerotic in origin and most of them are clinically silent; however, they may be complicated by myocardial ischemia or infarction, even in the absence of peripheral obstructive coronary artery disease, mainly caused by embolization of atheromatous debris or thrombi from within the aneurysm.2 Due to the rarity of the disease, there is not a consensus on the optimal treatment of left main aneurysms. Giant aneurysms represent an indication for surgical repair usually because of the potential for peripheral embolization, ischemic complications due to compression or even rupture. Surgical treatment may consist in patch repair, resection, exclusion and/or coronary artery bypass grafting.3–7 Smaller aneurysms without associated coronary artery disease may be treated conservatively provided adequate medical treatment with oral anticoagulants and antiplatelet drugs is carried out.8 In our patient a left main aneurysm was an occasional finding at coronary angiography. Its location at the left main bifurcation prevented insertion of an intracoronary stent, while absence of concomitant significant coronary disease and relatively small size excluded a surgical indication, favouring medical treatment with warfarin and aspirin.