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REVIEW article

Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1523352

Ischemia with No Obstructed Coronary Arteries and Microvascular Testing Procedures: A Review of Utility, Pharmacotherapy and Current Challenges

Provisionally accepted
Mohammad Al Bitar Mohammad Al Bitar 1Ronney Shantouf Ronney Shantouf 2Ashraf Al Azzoni Ashraf Al Azzoni 2Wael Al Mahmeed Wael Al Mahmeed 2Bassam Atallah Bassam Atallah 2*
  • 1 Royal College of Surgeons in Ireland, Dublin, Ireland
  • 2 Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates

The final, formatted version of the article will be published soon.

    Ischemia with No Obstructive Coronary Arteries (INOCA) is an increasingly recognized condition in patients presenting with angina and positive stress tests but without significant coronary artery stenosis. This review addresses the pathophysiology, diagnostic approaches, and management strategies associated with INOCA, emphasizing epicardial coronary spasms and coronary microvascular dysfunction (CMD) as underlying mechanisms, and myocardial bridging (MB) as a risk factor. Diagnostic modalities include both non-invasive techniques and invasive procedures, such as acetylcholine provocation testing, to differentiate vasospasm from microvascular causes. The paper discusses a potential interference between vasodilators used in transradial access and coronary spasm testing. Long-term management approaches for INOCA patients, including pharmacologic therapies and lifestyle interventions, are reviewed.

    Keywords: INOCA, ANOCA, microvascualar reisstance, microvascular dysfunction, CMD, functional testing, Myocardial bridge (MB), radial artery spasm

    Received: 05 Nov 2024; Accepted: 03 Feb 2025.

    Copyright: © 2025 Al Bitar, Shantouf, Al Azzoni, Al Mahmeed and Atallah. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Bassam Atallah, Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.