207 General discussion delivery involves using microbubbles to transport drug to the targeted region, such as the myocardium. When the microbubble reaches the myocardium, the microbubble can be destroyed using a high mechanical index, and this induces a temporary opening of the natural barriers such as the vessel walls (i.e. sonoporation). By combining sonoporation with the use of microbubbles for drug delivery, the medication could be more effective while also inducing less side effects. However, a limitation is the low concentration of microbubbles in the bloodstream, which could potentially be improved through localized administration. To conclude, while this thesis adds to the growing body of evidence supporting ANOCA as a substrate for chronic coronary syndrome, it also makes an important advancement by strengthening the recognition of ANOCA as a coronary ischemic disease. The perception of ANOCA as primarily a psychological disorder has shifted to the background, which has significantly improved the perspective for patients. Nevertheless, significant gaps remain in our understanding and future research on ANOCA into its different endotypes is essential to investigate, discover and improve existing uncertainties and enhance diagnostic and therapeutic approaches. 10
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