The Five Highest Growth Cardiovascular Procedures

#5. Cerebral thrombectomy.

The initial use of cerebral thrombectomy systems has been a disappointment. It is generally assumed that the situation with end-user adoption is likely to improve dramatically in two-three years from now, when results of the ongoing major U.S. and international trials with novel cerebral thrombectomy devices become available. Growth will exceed 11% annually through 2022.

#4 Below-the-knee drug-coated balloon angioplasty for superficial femoral artery. 

There is now a broad-based consensus among leading interventional radiologists that peripheral angioplasty using DCBs should be seen as a first-line revascularization option for both primary treatment and revision of advanced arterial occlusions in the SFA vascular territory. This will lead to better than 14% annual growth in these procedures through 2022.

#3 Transcatheter heart valve replacement. 

The use of transcatheter techniques in heart valve replacement and repair is projected to grow at over 14%, to be supported by the anticipated regulatory approval of TAVR procedures for intermediate risk patients in late 2016, and, plausibly, for standard surgical risk caseloads by 2019.

#2 Left atrial appendage endovascular closure in AFib.

The global volume of endovascular LAA closure procedures is projected to experience a robust double-digit growth expanding an average of over 14% annually, nearly doubling to an estimated 52 thousand corresponding interventions in the year 2022. Anticipated strong growth in the endovascular LAA closure utilization will be driven by increasing penetration of the Asian-Pacific (primarily Chinese and Indian) market geography with an extra boost from the recent U.S. launch of transcatheter LAA closure systems. Advances in the mature European market and emerging ROW marketplace are likely to stay below projected average growth rates.

#1 Lower extremity angioplasty and DES procedures.

Lower extremity angioplasty and drug-eluting stenting is forecast to increase almost three-fold from 2016 to 2022.

From 2015 to 2022, the cumulative global volume of PTA procedures is projected to expand an average of 4.2% per annum to year 2022. The cited expansion will be driven largely by a strong annual procedural growth in the APAC region (primarily in China and India undergoing aggressive transition to modern interventional radiology practices), which is forecast to account for about over a third of PTAs performed worldwide in 2022. The U.S. and Western European geographies can be expected to register only a moderate PTA procedural growth to be supported mostly by increasing penetration of the SFA patient caseloads with DES-based interventions, but the worldwide utilization of stented PTAs (especially these employing DES devices) is forecast to grow at significantly faster (4.2% and 19.1%) average annual rates to over 986,000 and 203,000 corresponding procedures in the year 2022.

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Source: MedMarket Diligence, Report #C500.


From “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022.” Report #C500.

 

 

The future of cardiovascular medicine

The MedMarket Diligence has published a global analysis and forecast of cardiovascular procedures, designed to be a resource for active participants or others with interest in the future of cardiovascular medicine and cardiovascular technologies.

See the press release on Medgadget.

New Global Cardiovascular Procedures Report Reveals Medtech Outlook

MedMarket Diligence has published, “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022.”

See link for report description, sources, table of contents, and list of exhibits. The report may be purchased for download.

The report details the therapeutic procedures that address acute and chronic conditions affecting myocardium and vascular system, with relevant prevalences, incidence rates, separate procedure counts for surgical versus interventional and other key splits of the procedure volume.

Screen Shot 2016-08-12 at 9.48.46 AMThe report offers current assessment and projected procedural dynamics (2015 to 2022) for primary market geographies (e.g., United States, Largest Western European Countries, and Major Asian States) as well as the rest-of-the-world.

Each set of forecasts is accompanied by discussion per condition of the changing clinical practice and technology adoption rates, procedural limitations or drivers competitively, the surgical-interventional balance, and the resulting market outlook for cardio manufacturers.

Excerpts available on request.

Surgical and interventional cardiovascular procedures, worldwide

In August 2016, MedMarket Diligence will be releasing Report #C500, “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022”. The report details prevalence, incidence, and caseload for the following procedures, forecast to 2022, and examines the clinical practice trends, technologies emerging on the market, and the dynamics leading to trends in procedures utilization and technology adoption.

Surgical and interventional procedures included:

  • Coronary artery bypass graft (CABG) surgery
  • Coronary angioplasty and stenting
  • Lower extremity arterial bypass surgery
  • Percutaneous transluminal angioplasty (PTA) with and without bare metal and drug-eluting stenting
  • Peripheral drug-coated balloon angioplasty
  • Peripheral atherectomy
  • Surgical and endovascular aortic aneurysm repair
  • Vena cava filter placement
  • Endovenous ablation
  • Mechanical venous thrombectomy
  • Venous angioplasty and stenting
  • Carotid endarterectomy
  • Carotid artery stenting
  • Cerebral thrombectomy
  • Cerebral aneurysm and AVM surgical clipping
  • Cerebral aneurysm and AVM coiling & flow diversion
  • Left Atrial Appendage closure
  • Heart valve repair and replacement surgery
  • Transcatheter valve repair and replacement
  • Congenital heart defect repair
  • Percutaneous and surgical placement of temporary and permanent mechanical cardiac support devices
  • Pacemaker implantation
  • Implantable cardioverter defibrillator placement
  • Cardiac resynchronization therapy device placement
  • Standard SVT & VT ablation
  • Transcatheter AFib ablation

In very general terms, the category “cardiovascular diseases” (CVD) refers to a variety of acute and chronic medical conditions resulting in the inability of cardiovascular system to sustain an adequate blood flow and supply of oxygen and nutrients to organs and tissues of the body. The CVD conditions could be manifested by the obstruction or deformation of arterial and venous pathways, distortion in the electrical conducting and pacing activity of the heart, and impaired pumping function of the heart muscle, or some combination of circulatory, cardiac rhythm, and myocardial disorders

The scope of this report covers surgical and interventional therapeutic procedures commonly used in the management of acute and chronic conditions affecting myocardium and vascular system. The latter include ischemic heart disease (and its life threatening manifestations like AMI, cardiogenic shock, etc.); heart failure; structural heart disorders (valvular abnormalities and congenital heart defects); peripheral artery disease (and limb and life threatening critical limb ischemia); aortic disorders (AAA, TAA and aortic dissections); acute and chronic venous conditions (such as deep venous thrombosis, pulmonary embolism and chronic venous insufficiency); neurovascular pathologies associated with high risk of hemorrhagic and ischemic stroke (such as cerebral aneurysms and AVMs, and high-grade carotid/intracranial stenosis); and cardiac rhythm disorders (requiring correction with implantable pulse generators/IPG or arrhythmia ablation).

The report offers current assessment and projected procedural dynamics (2015 to 2022) for primary market geographies (e.g., United States, Largest Western European Countries, and Major Asian States) as well as the rest-of-the-world.

The cited procedural assessments and forecasts are based on the systematic analysis of multiplicity of sources including (but not limited to):

  • latest and historic company SEC filings, corporate presentations, and interviews with product management and marketing staffers;
  • data released by authoritative international institutions (such as OECD and WHO), and national healthcare authorities;
  • statistical updates and clinical practice guidelines from professional medical associations (like AHA, ACC, European Society of Cardiology, etc.);
  • specialty presentations at major professional conferences (e.g., TCT, AHA Scientific Sessions, EuroPCR, etc.);
  • publications in major medical journals (JAMA, NEJM, British Medical Journal, etc.) and specialty magazines (CathLab Digest, EP Digest, Endovascular Today, etc.);
  • findings from relevant clinical trials;
  • feedbacks from leading clinicians (end-users) in the field on device/procedure utilization trends and preferences; and
  • policy papers by major medical insurance carriers on uses of particular surgical and interventional tools and techniques, their medical necessity and reimbursement.

Surgical and Interventional Procedures Covered in the report include:

  • Coronary artery bypass graft (CABG) surgery;
  • Coronary angioplasty and stenting;
  • Lower extremity arterial bypass surgery;
  • Percutaneous transluminal angioplasty (PTA) with and without bare metal and drug-eluting stenting;
  • Peripheral drug-coated balloon angioplasty;
  • Peripheral atherectomy;
  • Surgical and endovascular aortic aneurysm repair;
  • Vena cava filter placement
  • Endovenous ablation;
  • Mechanical venous thrombectomy;
  • Venous angioplasty and stenting;
  • Carotid endarterectomy;
  • Carotid artery stenting;
  • Cerebral thrombectomy;
  • Cerebral aneurysm and AVM surgical clipping;
  • Cerebral aneurysm and AVM coiling & flow diversion;
  • Left Atrial Appendage closure;
  • Heart valve repair and replacement surgery;
  • Transcatheter valve repair and replacement;
  • Congenital heart defect repair;
  • Percutaneous and surgical placement of temporary and permanent mechanical cardiac support devices;
  • Pacemaker implantation;
  • Implantable cardioverter defibrillator placement;
  • Cardiac resynchronization therapy device placement;
  • Standard SVT & VT ablation; and
  • Transcatheter AFib ablation

In 2016, cumulative worldwide volume of the aforementioned CVD procedures is projected to approach 15.05 million surgical and transcatheter interventions. This will include:

  • Roughly 4.73 million coronary revascularization procedures via CABG and PCI (or about 31.4% of the total),
  • Close to 4 million percutaneous and surgical peripheral artery revascularization procedures (or 26.5% of the total);
  • About 2.12 million cardiac rhythm management procedures via implantable pulse generator placement and arrhythmia ablation (or 14.1% of the total);
  • Over 1.65 million CVI, DVT, and PE targeting venous interventions (representing 11.0% of the total);
  • More than 992 thousand surgical and transcatheter heart defect repairs and valvular interventions (or 6.6% of the total);
  • Close to 931 thousand acute stroke prophylaxis and treatment procedures (contributing 6.2% of the total);
  • Over 374 thousand abdominal and thoracic aortic aneurysm endovascular and surgical repairs (or 2.5% of the total); and
  • Almost 254 thousand placements of temporary and permanent mechanical cardiac support devices in bridge to recovery, bridge to transplant, and destination therapy indications (accounting for about 1.7% of total procedure volume).

During the forecast period, the total worldwide volume of covered cardiovascular procedures is forecast to expand on average by 3.7% per annum to over 18.73 million corresponding surgeries and transcatheter interventions in the year 2022. The largest absolute gains can be expected in peripheral arterial interventions (thanks to explosive expansion in utilization of drug-coated balloons in all market geographies), followed by coronary revascularization (supported by continued strong growth in Chinese and Indian PCI utilization) and endovascular venous interventions (driven by grossly underserved patient caseloads within the same Chinese and Indian market geography).




The latter (venous) indications are also expected to register the fastest (5.1%) relative procedural growth, followed by peripheral revascularization (with 4.0% average annual advances) and aortic aneurysm repair (projected to show a 3.6% average annual expansion).

Geographically, Asian-Pacific (APAC) market geography accounts for slightly larger share of the global CVD procedure volume than the U.S. (29.5% vs 29,3% of the total, followed by the largest Western European states (with 23.9%) and ROW geographies (with 17.3%). Because of the faster growth in all covered categories of CVD procedures, the share of APAC can be expected to increase to 33.5% of the total by the year 2022, mostly at the expense of the U.S. and Western Europe.

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Source: MedMarket Diligence, LLC; Report #C500.

However, in relative per capita terms, covered APAC territories (e.g., China and India) are continuing to lag far behind developed Western states in utilization rates of therapeutic CVD interventions with roughly 1.57 procedures per million of population performed in 2015 for APAC region versus about 13.4 and 12.3 CVD interventions done per million of population in the U.S. and largest Western European countries.

See “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022”, Report #C500 (publishing August 2016).

List of high growth medtech products

Below is a table with a list of the market segments demonstrating greater than 10% compound annual growth rate for the associated region through 2022, drawn from our reports on tissue engineering & cell therapy, wound management, ablation technologies, stroke, peripheral stents, and sealants/glues/hemostats. Products with over 10% CAGR in sales are shown in descending order of CAGR.

RankProductTopicRegion
1General, gastrointestinal, ob/gyn, othertissue/cellWW
2Ophthalmologytissue/cellWW
3Organ Replacement/ Repairtissue/cellWW
4Urologicaltissue/cellWW
5Neurologicaltissue/cellWW
6Autoimmune Diseasestissue/cellWW
7CV/ Vasculartissue/cellWW
8Bioengineered skin and skin substituteswoundRest of A/P
9Peripheral drug-eluting stents (A/P)peripheral interventionalA/P
10Peripheral drug eluting stentsperipheral interventionalRoW
11Peripheral drug-eluting stents (US)peripheral interventionalUS
12Negative pressure wound therapywoundGermany
13Hydrocolloid dressingswoundRest of A/P
14Cancertissue/cellWW
15Foam dressingswoundRest of A/P
16Growth factorswoundRest of A/P
17Alginate dressingswoundRest of A/P
18Dentaltissue/cellWW
19Bioengineered skin and skin substituteswoundJapan
20Hemostatssealants, glues, hemostatsA/P
21Skin/ Integumentarytissue/cellWW
22Bioengineered skin and skin substitutessealants, glues, hemostatsUS
23Bioengineered skin and skin substitutessealants, glues, hemostatsWW
24Film dressingswoundRest of A/P
25Surgical sealantssealants, glues, hemostatsA/P
26Hydrogel dressingswoundRest of A/P
27TAA Stent graftsperipheral interventionalA/P
28Negative pressure wound therapywoundRoW
29Biological gluessealants, glues, hemostatsA/P
30FoamwoundRoW
31HydrocolloidwoundGermany
32AAA Stent graftsperipheral interventionalA/P
33Cerebral thrombectomy systemsstrokeA/P
34High-strength medical gluessealants, glues, hemostatsA/P
35Carotid artery stenting systemsstrokeA/P
36Cardiac RF ablation productsablationA/P
37Alginate dressingswoundGermany
38Peripheral venous stentsperipheral interventionalA/P
39Cerebral thrombectomy systemsstrokeUS
40Left atrial appendage closure systemsstrokeA/P
41Cyanoacrylate gluessealants, glues, hemostatsA/P
42Foam dressingswoundRest of EU
43Foam dressingswoundKorea
44Cryoablation cardiac & vascular productsablationA/P
45Bioengineered skin and skin substituteswoundGermany
46Thrombin, collagen & gelatin-based sealantssealants, glues, hemostatsA/P
47Cardiac RF ablation productsablationRoW
48Bioengineered skin and skin substituteswoundRoW
49Microwave oncologic ablation productsablationA/P

Note source links: Tissue/Cell, Wound, Sealants/Glues/Hemostats, Peripheral Stents, Stroke, Ablation.

Source: MedMarket Diligence Reports

Cardiovascular Surgical Procedures, Technologies Trended Globally to 2022

cardiovascular procedures

Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022. See Report #C500.

Publishing July 2016

This report covers surgical and interventional therapeutic procedures commonly used in the management of acute and chronic conditions affecting myocardium and vascular system. The latter include ischemic heart disease (and its life threatening manifestations like AMI, cardiogenic shock, etc.); heart failure; structural heart disorders (valvular abnormalities and congenital heart defects); peripheral artery disease (and limb and life threatening critical limb ischemia); aortic disorders (AAA, TAA and aortic dissections); acute and chronic venous conditions (such as deep venous thrombosis, pulmonary embolism and chronic venous insufficiency); neurovascular pathologies associated with high risk of hemorrhagic and ischemic stroke (such as cerebral aneurysms and AVMs, and high-grade carotid/intracranial stenosis); and cardiac rhythm disorders (requiring correction with implantable pulse generators/IPG or arrhythmia ablation).

The report offers current assessment and projected procedural dynamics (2015 to 2022) for primary market geographies (e.g., United States, Largest Western European Countries, and Major Asian States) as well as the rest-of-the-world.

See the complete table of contents at Report C500.

 

 

Cerebral Aneurysm and AVM Embolization Systems

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.

Cerebral thrombectomy systems

Selected Cerebral Thrombectomy Systems on the U.S. and International Markets

From the 2015 report, “Emerging Global Market for Neurointerventional Technologies in Stroke, 2014-2019”.

CompanyDeviceFeaturesVessel RangeDevice Sizes (D/L)Regulatory Status
AcandisAperioSelf-expanding nitinol stent-based device with hybrid cell design and adaptable working length1.5 to 5.5 mm3.5, 4.5, 6.0 mm / 28, 30 or 40 mmCE Marked
BALTCatch+ Mini/, Catch+, Catch+ Maxi, Catch+ MegaSelf-expanding 16-wire nitinol baskets with tapering cell size design, closed distal tip and 3 distal-1 proximal radiopaque markers2.0 to 7.0 mm3.0, 4.0, 6.0, 9.0 mm / 15, 20, 30, 55 mmCE Marked
Codman /DePuyRevive SESelf-expanding nitinol basket with hybrid cell design, closed distal tip, and 3 radiopaque markers1.5 to 5.5 mm2.5, 3.0, 3.5, 4.0, 5.0, 6.0 mm / 20, 30, 40 mmCE Marked, Approved in China, South Korea, and Taiwan
CovidienSolitaire FRSelf-expanding nitinol stent-based device with Parametric design (for multiple planes of clot contact to enhance capture). Features 3 or 4 distal and 1 proximal markers2.0 to 5.5 mm4.0, 6.0 mm /26, 31, 42 mmCE Marked, FDA approved
NeuraviEmbotrapSelf-expanding nitinol stent-based device with open cell design, closed distal tip, and 3 radiopaque markers. Features dilating inner channel for rapid flow restoration and integrated distal and side branch protection2.0 to 5.5 mm3.0, 4.0, 6.0 mm / 15, 20, 30, 55 mmCE Marked
PenumbraPenumbra SystemAspiration based system comprised of vacuum pump, specialty clot capture & retrieval catheters, and Separator> 3 mm3.0, 4.0, 5.0 mm / 26 mmCE Marked, FDA approved, available in Asia, Australia, and South America
PhenoxpREsetSelf-expanding nitinol stent-based tapering device with closed ring design, and stable proximal opening2.0 to 4.0 mm4.0, 6.0 mm / 30, 45 mmCE Marked
StrykerTrevo Pro, Trevo View, Trevo XPLine of self-expanding nitinol stent-based devices (standard, all radiopaque, oversized) with spiral cell design and soft, guidewire-like closed distal tip1.5 to 4.0 mm4.0, 5.0, 6.0 mm / 20, 30, 40 mmCE Marked, FDA approved

Source: MedMarket Diligence, LLC; Report #C310.

Peripheral Vascular Stenting to 2020

First introduced about two decades ago as a bailout technique for suboptimal or failed iliac angioplasty, peripheral vascular stenting gradually emerged as a valuable and versatile tool for a variety of primary and adjuvant applications within non-coronary vasculature.

Today, peripheral vascular stenting techniques are commonly employed in the management of the most prevalent occlusive circulatory disorders and other pathologies affecting abdominal and thoracic aortic tree and lower extremity arterial bed. Stents are also increasingly used in the management of the debilitating conditions like venous outflow obstruction associated with deep venous thrombosis and chronic venous insufficiency.

Peripheral vascular systems include lower extremity bare metal and drug-eluting stents for treatment of symptomatic PAD and critical limb ischemia resulting from iliac, femoropopliteal and infrapopliteal occlusive disease; stent-grafting devices used in endovascular repair of abdominal and thoracic aortic aneurysms; as well as a subset of indication-specific and multipurpose peripheral stents used in recanalization of iliofemoral and iliocaval occlusions resulting in CVI.

In 2015, these peripheral stenting systems were employed in ovet 1.5 million revascularization procedures worldwide, of which lower extremity arterial stenting accounted for 81% of such interventions, followed by abdominal aortic aneurysm and thoracic aortic aneurym endovascular repairs.

Clinicians in the U.S. performed 34.1% of worldwide covered peripheral arterial and venous procedures,  followed by the major Western European countries (33.1%), major Asian-Pacific states (24.4%), and the rest-of-the-world with 8.4% of peripheral stent-based interventions.

During the forecast period, the global volume of peripheral arterial and venous stenting procedures is projected to grow an average of 5.5% and 6.2% per annum, generating over $4,620 million in cumulative product revenues in the year 2020.

The largest relative and absolute dollar gains in all covered product segments can be expected in Asian-Pacific market geography based on rapid transition to modern interventional radiology practices and availability of funding in China. Similar, but somewhat slower growth trends might be observes in the ROW zone, albeit from a much lower base.

Highly mature U.S. and Western European markets are likely to register relatively modest advances both in corresponding procedure volumes and device sales.

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Source: MedMarket Diligence, LLC; Report #V201, “Global Market Opportunities in Peripheral Arterial and Vascular Stents, Forecast to 2020” publishing February 2016).

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Source: MedMarket Diligence, LLC; Report #V201

 

Forecasts for neurointerventions in acute stroke

Over the past two decades, one could witness the advent and significant expansion of the neurointerventional armamentarium targeting management of acute stroke. In mid-1990s, endovascular coiling embolization tools and techniques for treatment of cerebral aneurysms and AVMs (arterio-venous malformations) were introduced as a less invasive alternative to craniotomy-based surgery in primary prevention of hemorrhagic stroke. Several years later, these techniques were supplemented with coil-containing stents, which enabled treatment of large, giant, and wide-neck aneurysms. The latter was followed by the launch of stent-based flow diversion systems, which allowed clinicians to hemoisolate such aneurysms without tedious and risky coil packing of the rupture-prone aneurysmal sac.

In primary ischemic stroke prevention, development of embolically-protected carotid stenting and left atrial appendage closure techniques provided clinicians with an option of using non-inferior transcatheter tools instead of customary surgical interventions.

Finally, a recent launch of the novel stent-based cerebral thrombectomy systems manifested a qualitative breakthrough in emergent treatment of acute cerebral ischemia, where marginally effective and severely caseloads restrictive intravenous tPA therapy represented the only available therapeutic option.

Presently, endovascular techniques are increasingly seen and used by practicing clinicians as preferred therapeutic modalities in prophylaxis and treatment of acute stroke and are likely to expand their role in the years to come.

Based on the industry reporting and other estimates, in 2014, approximately 227.3 thousand cerebral endovascular therapeutic procedures were performed worldwide. Prophylaxis of ischemic stroke via carotid artery stenting and left atrial appendage (LAA) closure with contributed 91.2 thousand and 11.9 thousand interventions (or 40.1% and 5.2%, accordingly), followed by transcatheter embolization of intracranial aneurysm and AVM for hemorrhagic stroke prevention with 90.5 thousand interventions (or 39.8%), and cerebral thrombectomy-based emergent treatment of acute cerebral ischemia with 33.7 procedures (or 14.8% of the total).

Geographically, Western Europe and the U.S. accounted for the largest shares of corresponding cerebrovascular interventions in 2014, with 35.7% and 35.0%, accordingly, followed by major APAC states with 19% and rest-of-the-world with the remaining 10.3% of the total procedures performed.

Source: MedMarket Diligence, LLC; Report #C310.