treatment and observation may be appropriate in selected, low-risk patients. importantly, untreated carriers of significant acaos should not generally engage in competitive sports or strenuous activities. treatment options for acaos-im include both catheter-based procedures (percutaneous coronary intervention ) and surgical interventions. pci consists of stent angioplasty of the proximal, intramural segment by placing a thin metal tube (a stent) in order to keep open the narrowed artery. pci of r-acaos-im is feasible and quite successful, but further experience is needed in l-acaos-im since few cases have been treated percutaneously, while surgery is the recommended treatment in this subpopulation, at this time. surgery consists of “unroofing” or denudation of the intramural coronary segment from the aortic wall: this approach is currently the gold standard. coronary artery bypass grafting (cabg) and reimplantation of the ectopic artery are obsolete and not indicated, because of competitive flow in mild resting narrowings.