Coronary stents operate at a certain nexus of different therapeutic alternatives for the treatment of coronary artery disease. Given advances in materials technologies, biotech, drug-device hybrids, drug delivery and other fields, the therapeutic options available to the physician (interventional cardiologist or cardiac surgeon) for the treatment of coronary artery disease have proliferated.
Any competitor marketing treatment for coronary artery disease will of necessity consider the competitive threat of bare versus drug-eluting stents, angioplasty, atherectomy (waning but not gone), products for identification/treatment of vulnerable plaque, traditional coronary artery bypass, MIDCAB, OPCAB and other bypass variants (e.g. robotics), percutaneous bypass, atherosclerosis-reversing drugs and others.
For the manufacturer, it is a complex competitive landscape. For example, it once was the case that any angioplasty manufacturer could reasonably consider his/her competitors to be limited to those manufacturers of devices that produce catheter-based recanalization of the atherosclerotic lumen. Those days are gone, for woe the angioplasty manufacturer now who does not also consider atherectomy, transmyocardial laser revascularization, bare metal stents, drug-eluting stents, traditional/open, MIDCAB (and similar) or and even percutaneous coronary artery bypass graft, let alone the classes of drugs and other non-device approaches to produce non-surgical reversal of atherosclerosis.
Coronary stents in general, and drug-eluting stents in particular, do indeed represent somewhat an insulated market, given recent clinical trial successes and adoption in the marketplace, but the size of the stakes in heart disease and the number and variety of alternative technologies virtually guarantee that that status quo will not remain so for long.
Coronary stents are the subject of the April 2009 report, "Worldwide Drug-Eluting, Bare, Bioresorbable and Other Coronary Stents, 2008-2017," from MedMarket Diligence.