Coronary atherosclerotic aneurysms (CAA) are a very uncommon finding in patients presenting with coronary artery disease. In order to prevent spontaneous vessel rupture in patients presenting with large CAA, these patients are frequently treated with the implantation of a stent-graft. However, these devices have a high rate of restenosis, which limits the clinical success of this strategy at mid-term. We present a patient with a native CAA who was treated with the implantation of a stent-graft with in-stent ad- hoc implantation of a paclitaxel-eluting stent. Coronary angiography and intravascular ultrasound demonstrated absence of restenosis and persistence of the exclusion of the aneurysm at 1-year follow-up.