Saccular aneurysm and stenosis of the left anterior descending artery presenting with acute coronary syndrome. What is the best treatment: CABG or PCI?

Treatment of coronary artery aneurysms (CAAs) can either take the way of a close regular follow up with antiplatelet and anticoagulation therapy, percutaneous coronary intervention with possible stenting, or reach the extent of doing coronary artery bypass grafting. The severity of coexistent coronary artery stenosis, symptomatology, embolization to distal coronary beds, and increasing measurements over time are key players to decide whether to proceed with surgery in patients with CAAs. <Learning objective: (i) Coronary artery aneurysms (CAAs) are defined as luminal dilation 50% larger than that of the adjacent reference segment. They are found in 1.4% of patients and could have multiple shapes and forms. (ii) Up to one-third of CAAs are associated with obstructive coronary artery disease and have been associated with myocardial infarction, arrhythmias, or sudden cardiac death. (iii) Treatment of CAAs can be medical, or invasive by performing percutaneous coronary intervention, or surgical using coronary artery bypass grafting. (iv) The severity of coexistent coronary artery stenosis, symptomatology, and embolization to distal coronary beds are important in the final decision on treatment modality.>.