An 84-year-old male with past history of hypertension, aneurysmal coronary artery disease (CAD), abdominal aortic aneurysm (AAA) treated previously with endovascular repair 2 years ago presented for surveillance of his AAA repair. Computed tomography angiogram (CTA) revealed persistent endoleak from the repaired AAA. It also demonstrated interval growth of previously known right coronary artery (RCA) aneurysm from 4 cm to 7 × 8 cm in diameter (). Patient denied any symptoms including angina but was admitted to the hospital for further work-up. Vital signs at the time of admission revealed a blood pressure of 159/78 mmHg, heart rate of 65 beats/min, oxygen saturation (SpO2) of 95% on room air. Physical examination was otherwise unremarkable. At home, he was on low dose daily aspirin and high intensity rosuvastatin for known CAD and CAA. His electrocardiogram (EKG) showed inferior lead Q waves suggesting previous inferior infarction and occasional premature ventricular complexes (). Cardiac troponin was unremarkable. Transthoracic echocardiogram showed borderline left ventricle ejection fraction of 50% with inferolateral wall hypokenesis. It also revealed a large CAA containing partially thrombosed material and compressing the right ventricle inflow at the level of tricuspid valve, consistent with patient’s previous history of RCA aneurysm (). A review of patient’s myocardial perfusion scan performed 2 years back for pre-operative evaluation showed mixture of scar and ischaemia in the left circumflex coronary artery (LCx) territory. Coronary angiography (CA) was performed which showed diffuse aneurysmal and obstructive coronary artery disease with a giant partially thrombosed mid-vessel RCA aneurysm, 7 × 8 cm in its greatest dimensions with distal chronic total occlusion (). Retrograde collaterals from left circumflex (LCx) were seen filling the RCA. Diffuse small-sized multiple aneurysms of left anterior descending artery with multiple areas of complex 75% narrowing and mid-vessel LCx ectasia/small aneurysm with complex 50–70% stenosis were also seen on CA. Vascular surgery recommended no further intervention for the AAA as they deemed the endoleak to be stable after carefully reviewing the images. However, considering the massive size and rapid growth of the RCA aneurysm with impending risk of rupture and sudden death, percutaneous management with coil embolization was considered as the size of the aneurysm precluded stenting as an option and patient’s age, frailty, and comorbidities made surgery prohibitive. Patient underwent successful coiling of the aneurysm and proximal RCA using seven coils with good recovery. At discharge, patient’s aspirin and statin were resumed.