Key result
Surgical treatments such as transmyocardial revascularization and sympathetic denervation may reduce coronary vasospasm in refractory INOCA, though current clinical data remains limited.
Why the study?
Despite the lack of major obstructive lesions, patients with INOCA often present with chest pain, making diagnosis and management a significant challenge.
Emerging surgical and interventional treatments may offer hope for INOCA patients with refractory symptoms, highlighting the need for further clinical trials.
INOCA interventions lack definitive evidence; leaves open optimal management pending targeted RCTs.
BACKGROUND: Ischemia with no obstructive coronary artery disease (INOCA) is characterized by myocardial ischemia in the absence of significant coronary artery stenosis. Despite the lack of major obstructive lesions, patients often present with chest pain, making diagnosis and management a significant challenge. MATERIALS AND METHODS: A comprehensive search strategy of electronic databases (2000 to 2024) was used to identify studies assessing pathophysiology, diagnosis, surgical treatments, interventions, and outcomes in INOCA. Clinical trials, observational studies, case-control studies, and cohort studies were included. RESULTS: Emerging surgical treatments may have a role in certain subgroups of INOCA patients, particularly those with severe and persistent symptoms or underlying pathophysiological factors that do not respond adequately to pharmacological therapies. Transmyocardial revascularization (TMR) and sympathetic denervation procedures reduce coronary vasospasm in refractory angina. Trials have shown promise for coronary sinus occlusion. Autologous stem cell therapy is an innovative surgical approach that has shown promise in early trials but remains investigational. Selective surgical cardiac vein retroperfusion remains largely experimental, with limited clinical data. CONCLUSIONS: This review highlights the need for ongoing research and clinical trials to assess the effectiveness of surgical and nonsurgical options in INOCA. Although current data on surgical interventions is limited, these treatments may offer hope for patients with refractory symptoms. A personalized and multidisciplinary approach to management is essential for optimal patient outcomes.
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Viola et al. (2025) conducted a review in Ischemia with no obstructive coronary artery disease (INOCA). Surgical treatments (e.g., transmyocardial revascularization, sympathetic denervation, coronary sinus occlusion) was evaluated. Surgical treatments such as transmyocardial revascularization and sympathetic denervation may reduce coronary vasospasm in refractory INOCA, though current clinical data remains limited.
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