Coronary dysfunction encompasses a spectrum of pathophysiologically distinct endotypes with differing therapeutic implications. The aim of this article was to provide an overview of device-based therapies targeting the various forms of coronary dysfunction. A systematic review of the available literature was performed. Multiple device-based strategies have been proposed for the treatment of angina in the absence of obstructive coronary artery disease, reflecting the heterogeneity of underlying mechanisms, and tailored approaches based on specific endotypes may improve symptom control and clinical outcomes.