The ultimate objective of cerebral endovascular embolization is to hemoisolate rupture-prone or ruptured neurovascular abnormality from cerebral circulation with the view of preventing major primary or secondary hemorrhage into intracranial space. Technically, cerebrovascular embolization is accomplished through a transcatheter deployment of one or several embolizing agents into the unstable aneurysmal sac or AVM’s fundus in the amount sufficient for eventually arresting an internal blood flow and prompting lesion obliteration.
In cases involving large, giant and wide neck aneurysms, stent-assisted coiling or coil-free flow diversion device-based embolization are typically utilized.
Cerebral endovascular embolization systems include microcoils and liquid embolics with associated transcatheter delivery devices (e.g., micro guidewires, microcatheters, etc.), as well as coil-containing stents and flow diversion devices.
In recent years, transcatheter embolization techniques have emerged as a mainstay treatment modality in repair of rupture-prone cerebral aneurysms and indispensable presurgical adjunct in treatment of intracranial AVMs.
Aside from the ongoing (but gradually moderating in the U.S. Europe and Japan) migration of patients from open surgical to minimally invasive neurovascular embolization techniques, consistent and robust growth in this market was driven by the introduction of improved and premium-priced embolic coil designs, launch of coil containing stents for wide neck aneurysms, and increasing utilization of user-friendly liquid embolics in AVM (and selected wide neck aneurysm) applications.
In the forthcoming years, the cited growth factors are likely to stay in place supporting further expansion of cerebral aneurysm and AVM transcatheter embolization business.
In 2014, endovascular embolization techniques were employed in approximately 90.5 thousand cerebral aneurysm and AVM repair procedures worldwide, of which aneurysm targeting interventions accounted for about 89.2%, with the rest contributed by AVMs hemoisolation.
Cumulative global sales of cerebral endovascular embolization products were estimated at about $851 million in 2014, of which U.S. accounted for $339.8 million (or 39.9%), followed by the largest Western European states with 242.1 million (or 28.5%), major Asian-Pacific states with $178.9 million (or 21.1%), and the rest-of-the-world with the remaining $89.4 million (or 10.5% of the total).
During the forecast period, the total global volume of transcatheter neurovascular embolization procedures is projected to grow 4% per annum to an estimated 109.9 thousand interventions in the year 2019. The largest absolute and relative gains in cerebral embolization procedure volumes are expected in the largest Asian-Pacific states (mostly China) and the Rest-of-the-World, where low relative usage of endovascular techniques (30-35% versus 65-75% in the U.S. and Europe) will continue to support their increasing penetration of clinical practices and serve as the primary locomotive of growth in the corresponding global product market. Largely mature U.S. and West European market geographies are likely to register considerably more modest advances in cerebral embolization procedure volumes.
The worldwide sales of cerebral aneurysm and AVM embolization products are forecast to expand at a slightly slower 3.6% average annual rate to an estimated $1,017 million in the year 2019. The largest relative and absolute gains in the market can be expected in the flow diversion system segment which is projected to grow an average of 20.7% annually and add over $96 million in product sales to a total of $157.7 by 2019.
Geographically, grossly underpenetrated Asian-Pacific and ROW markets are likely to register the fastest growth expanding 7.1% and 7.6% per annum to approximately $253.3 million and $128.9 million in 2019, accordingly.
From, “Emerging Global Market for Neurointerventional Technologies in Stroke, 2014-2019,” Report #C310.