Coronary artery ectasia (CAE) is a dilation of the coronary artery lumen. The term "ectasia" differs from "coronary aneurysm". The first one refers to diffuse dilation of a coronary artery, while the second designate a focal coronary dilation. In most of cases, it is associated with atherosclerotic disease. CAE predispose to acute coronary events because it disturbs coronary flow and increases blood viscosity. Conventionally, CAE was treated by oral anticoagulants and it has been considered as a valid treatment option. The usual treatment of acute coronary syndrome (ACS) including dual antiplatelet therapy (DAPT) is widely employed in CAE patients presenting with ACS.We report the case of a 71year-old man who suffered from angina chest pain revealing a myocardial infraction with inferior ST-elevation. Coronary angiography demonstrated diffused coronary artery ectasia with thrombotic occlusion in the distal segment of right coronary artery. It was managed with medical treatment including DAPT and oral anticoagulation.