neurysmal dilation of coronary arteries is found in up to 5% of patients undergoing cor- onary angiography (1). The presence of coro- nary aneurysm or ectasia has been associated with poor long-term outcomes irrespective of the presence of concomitant atherosclerotic coronary artery disease (2–4). Clinical presentations range from incidental finding on cardiac imaging to acute coronary syn- drome (5). Treatment options include medical man- agement, surgical excision, coronary bypass grafting (CABG), and percutaneous coronary interventions (PCI). However, due to the lack of randomized trials or societal recommendations, the management of these patients poses a clinical dilemma to the clinician. The aim of this paper is to provide a concise overview of the pathophysiology, classification, clinical presen- tation, assessment, and management strategies of aneurysmal coronary disease.