A Review on the Coronary Artery Disease Landscape: Tissue and Market Analysis, Treatments, and Trials

Coronary artery disease (CAD) remains the leading global cause of morbidity and mortality, driven by progressive atherosclerotic plaque accumulation within the coronary arteries. The pathogenesis involves complex structural, cellular, and molecular alterations, including endothelial dysfunction, smooth muscle cell phenotypic switching, extracellular matrix remodeling, vascular stiffening, and chronic inflammation. Current pharmacologic, surgical, and device-based interventions mitigate symptoms but do not reverse disease progression. As a result, the global CAD market continues to expand rapidly, with significant growth driven by an aging population, lifestyle risk factors, technological innovation, and increased awareness of cardiovascular health. This review provides a comprehensive overview of the biological mechanisms underlying healthy and diseased coronary tissue, analyzes market trends and drivers, and evaluates both established and emerging treatment modalities. Novel technologies in stent design, intravascular lithotripsy, orbital atherectomy, and RNA-based therapeutics are highlighted, alongside early-stage tissue engineering approaches under investigation. Together, these developments reflect the ongoing shift toward more targeted, durable, and patient-specific strategies in the management of CAD.