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Ischemia with No Obstructive Coronary Artery Disease (INOCA): A Review
Laura Viola1, Megan Masters1, Umar Shafiq1
1Division of Cardiac Surgery, University Hospital Southampton, Southampton SO16 6YD, UK.
Insights
Ischemia with no obstructive coronary artery disease (INOCA) presents diagnostic challenges. Emerging surgical treatments show promise for refractory symptoms, but more research is needed.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Ischemia with no obstructive coronary artery disease (INOCA) involves myocardial ischemia without significant coronary stenosis.
- Patients experience chest pain, posing diagnostic and management difficulties.
Purpose of the Study:
- To review current and emerging surgical treatments for INOCA.
- To assess the role of interventions in managing refractory INOCA symptoms.
Main Methods:
- Comprehensive literature search (2000-2024) of electronic databases.
- Inclusion of clinical trials, observational, case-control, and cohort studies.
- Focus on pathophysiology, diagnosis, surgical treatments, interventions, and outcomes.
Main Results:
- Surgical options like transmyocardial revascularization (TMR) and sympathetic denervation may help severe INOCA.
- Coronary sinus occlusion shows promise; autologous stem cell therapy is investigational.
- Limited data exists for selective surgical cardiac vein retroperfusion.
Conclusions:
- Ongoing research and trials are crucial for evaluating INOCA treatments.
- Surgical interventions offer potential hope for patients with refractory symptoms.
- Personalized, multidisciplinary management is key for optimal INOCA patient outcomes.
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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