Coronary aneurysms are abnormal dilations of the coronary arteries. This can occur as post-stenotic dilation during atherosclerotic 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.