We report on a 51-year-old Japanese female with bilateral coronary artery aneurysms. Severe calcified aneurysms were detected in the proximal right coronary artery (RCA) and left anterior descending branch (LAD). The RCA was totally occluded and supplied by the blood flow via septal branches of the LAD. A two-stage management plan, including an off-pump coronary artery bypass grafting for the RCA with a right gastroepiploic artery and catheter angioplasty with an autologous vein graft-coated stent for the LAD, was successfully completed. Prophylactic treatments for coronary artery aneurysm are still controversial, therefore, minimal invasive procedures should be favored to prevent acute cardiac shock or sudden death related to aneurysmal obstruction.