Coronary aneurysms are abnormal dilations of the coronary arteries. This can occur as post-stenotic dilation during ahteroslcerotic coronary disease or can occur as a part of a vasculitis. Kawasaki's disease during childhood can lead to coronary aneurysms in adulthood causing ischemic heart disease and angina. When the coronary aneurysms are large. the pathophysiologic mechanism of ischemia is thought to be due to microemboli and thus anticoagulation with warfarin is frequently utilized although there is no clinical data to support this therapy. Surgical therapy is reserved for severe, refractory cases. Using this approach, the coronary aneurysms are ligated and then bypassed using standard techniques to provide distal coronary flow.Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of largescale outcome data on their various treatment modalities, coronary artery aneurysms and coronary ectasia pose a challenge to the managing clinician. This paper aims to provide a succinct review of aneurysmal coronary disease, with a special emphasis on the challenges associated with its interventional treatment.v