A 'clover' coronary artery: role of coronary computed tomography to indicate optimal treatment in aneurysmal coronary artery disease

We report the case of a 61-year-old man referred to our department for exertional angina with a history of tri-vessel aneurysmal coronary artery disease. Exercise stress echocardiography was positive for inferior wall hypokinesia. Coronary computed tomography (CT) provided a more accurate characterization of the coronary aneurysms. It detected a laminated thrombus of the proximal left anterior descending and a clover-like aneurysmal dissection of the proximal right coronary artery, which questioned the feasibility of coronary angioplasty. So, the patient was treated with medical therapy only. This case confirmed the importance of coronary CT as diagnostic tool for procedural risk assessment and definition of the most appropriate treatment in patients with coronary aneurysms.