Mincione Gianluca, Maurina Matteo, Benedetti Alice, Chiarito Mauro, Stefanini Giulio G, Smits Pieter C, Paradies Valeria
Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Cardiology, Niguarda Hospital, Milan, Italy.
Cardiovasc Revasc Med. 2025 Jul;76:25-29. doi: 10.1016/j.carrev.2025.06.015. Epub 2025 Jun 16.
In interventional cardiology, our efforts have traditionally centered on treating lesions in the epicardial coronary arteries, which can be visualized on coronary angiography. However, a significant proportion of patients experience similar symptoms to those with epicardial coronary artery lesions, yet without any angiographically visible coronary artery disease. These cases fall under the spectrum of coronary microvascular dysfunction. In this review, we will explore the disease's pathophysiology and focus on new frontiers in terms of diagnostic approaches and therapeutic strategies according to different endotypes.