Minimally-invasive device-based approaches for improving cardiac perfusion

Improvements in medical therapy and coronary revascularization have led to an increased survival rate in patients with coronary artery disease (CAD), with a consequent growing number of patients with severe and diffuse CAD which is not amenable to further revascularization procedures. The majority of these patients have either angina pectoris refractory to optimal medical therapy or chronic heart failure symptoms. While the goal of therapy in refractory angina pectoris patients should mostly be directed at improving patients’ symptoms and quality of life, therapy in severe diffuse CAD should be focused on myocardial ischemia reduction and survival improvement. In recent years, a number of innovative non-pharmacological therapeutic options, aimed at improving angina symptoms and quality of life by reducing myocardial ischemia, have been investigated in this challenging patient group. We summarize the different non-pharmacological therapeutic options that are available or are under development, aimed at improving myocardial perfusion in patients with proven myocardial ischemia and CAD not amenable to further revascularization.