 Although several causes have been reported, atherosclerosis accounts for 50 of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. The natural history and prognosis remains obscure, since definitive data are scarce. Controversies persist regarding the use of medical management antithrombotic or interventionalsurgical procedures. 