An acute coronary syndrome in a patient with left main coronary aneurysm.

: Aneurysms of the left main coronary artery are a rare entity, being found in 0.1% of angiograms. This case involves a middle aged man with left main coronary aneurysm, complicated with severe obstruction at the ostium of the left anterior descending artery, the ostium of a ramus, and the ostium of the left circumflex artery. The etiology in this case is not certain, but it may have been due to Kawasaki disease or cocaine toxicity. The patient developed an acute coronary syndrome and underwent successful by-pass surgery.