A 70-year-old man presented to our hospital with non-ST elevation myocardial infarction and severely depressed left ventricular systolic function. Coronary angiogram revealed a giant fusiform aneurysm of the proximal left anterior descending artery with significant stenoses immediately proximal and distal to it and a left circumflex chronic total occlusion. The patient was treated surgically, with ligation and bypass of the aneurysm using a radial artery graft and a vein graft to the first obtuse marginal branch.