Cardiovascular procedure volume growth (interventional and surgical)

Cardiovascular surgical and interventional procedures are performed to treat conditions causing inadequate blood flow and supply of oxygen and nutrients to organs and tissues of the body. These conditions include 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. Specifically, these procedures are:

  • 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

For 2016 to 2022, the total worldwide volume of these cardiovascular procedures is forecast to expand on average by 3.7% per year 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).

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).

Source: MedMarket Diligence, LLC; “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022,” (Report #C500).

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.

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.

Source: MedMarket Diligence, LLC; “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022,” (Report #C500).


Global Cardiovascular Procedures report #C500 details the current and projected surgical and interventional therapeutic procedures commonly used in the management of acute and chronic conditions affecting myocardium and vascular system.

Coronary artery disease treatment map

As an exercise, I found it worthwhile to map out the various options available or under development for the treatment of coronary artery disease.

We assess the emphasis of current, near-term and future possible options for treatment in the color-coded scheme:

Bold, black:  Current, dominant treatment options

Green:  Near term options with potential to gain significant caseload

Red:  Long-term option with potential to dominate all caseload

 

 

Source: MedMarket Diligence, LLC; Report #C245

Stents for treatment of coronary artery disease at convergence of therapy alternatives

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.