Current Trends in Neurovascular Intervention and Upcoming Product Launches

Neurovascular Intervention is a specialized field of neuroscience, which involves treatment of neurological disorders like intracranial aneurysm, ischemic stroke, arteriovenous malformation and carotid stenosis & others. According to Brain Aneurysm Foundation in U.S., about 6 million people suffer unruptured aneurysm and women suffer more than men in the ratios of 3:2. These neurovascular diseases are seen among aged population as they are more prone to such diseases due to slow cerebrovascular auto regulation ability. According to OECD (Organization for Economic Co-operation and Development), at least one in four people will be aged over 65 by 2050 in about two-thirds of OECD countries. The aging population is rising from 5% to 15% in Spain, Germany and from 6% to 16% in Japan.

The procedures taking place in neurovascular intervention field are artificial embolization, stenting and mechanical thrombectomy. Artificial embolization is a minimally invasive procedure carried out by microcatheter insertion into the vessel to treat abnormal blood vessels in the brain or aneurysm by reducing blood flow to abnormal areas or locations of blood loss and this procedure is an alternative to open surgery. Artificial Embolization treats intracranial aneurysm and arteriovenous malformations. Artificial embolization devices are coils, liquid embolics, flow diverter and flow disruptor. Stenting procedure is done to treat carotid stenosis, intracranial aneurysm and intracranial stenosis with products like carotid stents and intracranial stents which are implanted into the artery. The carotid stents keep the carotid arteries wide open once they are widened with angioplasty done in order to restore blood flow to the brain. Intracranial stents include aneurysm coil stent, neck reconstruction stent and stent graft are used to treat intracranial aneurysm. Neurovascular thromobectomy is a mechanical endovascular treatment done to remove blood clot present in the brain which leads to stroke. Thrombectomy devices are stent retrievers and aspiration devices.

According to IQ4I Analysis, Neurovascular Intervention device market is expected to reach $4,473.2 million by 2024 and grows at a single digit CAGR. The increase in incidence and prevalence of neurovascular diseases like cerebral aneurysm, stroke, arteriovenous malformations and increase in aging population. The technological advancement, acquisitions and favourable reimbursements are some of the opportunities that are propelling the growth of the market.

Neurovascular intervention device market is growing rapidly due to increase in neurovascular disease, product launches with technological advancements and increase in aging population. In addition to this, several companies are investing in their R&D activities to develop innovative products. Some of the advancements in this field are the development of soft coils, integrated balloon system, advancements in flow diverter and adjustable clot retriever. Inspite of using embolic protection filters there are chances of emboli escaping during carotid stenting which can lead to stroke, hence lead to development of Paladin Carotid Post-Dilation Balloon System by Contego Medical which is an integrated embolic protection with an angioplasty balloon and an integrated 40 μm filter which is capable of capturing small emboli, coupled together for the first time. The Paladin System is CE marked and available in select European markets.

Embolic coils are developed by soft coil technology for e.g. Target detachable nano coil by Stryker is designed to treat small spaces and delivers increased conformability and shape adjustment. For instance, Cerenovus a part of Johnson & Johnson company has launched Galaxy G3 mini coil in 2018, the smallest and softest embolic finishing coil, for use in the endovascular treatment of cerebral aneurysms and haemorrhagic stroke. The company also received 510 (k) clearances for the device from U.S. Food and Drug Administration (FDA) in late September 2017.

The currently marketed clot retrievers exert pressure on the vessel wall which leads to further complications like vessel damage. Hence lead to development of a new mechanical thrombectomy system which is adjustable clot retriever developed by Rapid Medical company, wherein the diameter of the mesh and the radial force of the vessel wall can be adjusted by the handle and thereby does not cause any stress to the vessel. The device is indicated to restore blood flow in the large intracranial vessel and is composed of fully foldable structure in thin metal wire of nitinol which expands according to the diameter of the vessel. Another added advantage is the presence of mesh which is radiopaque in nature for better visibility inside the vessels and no need of necessary the long antiplatelet therapy as required in the case of stent implantation.

Even though the flow diverter has proven for treating sidewall aneurysm by overcoming the limitations of traditional endovascular coiling but the management of large bifurcation aneurysm still remains challenge as they required coiling with adjunctive devices like temporary balloon protection which further leads to higher chances of complications. Hence lead to development of intrasaccular flow disruption i.e. Woven endobridge by Sequent Medical (Terumo) which is a self expanding braided mesh made of nitinol wires and mix of other wire diameter or materials which gives an tailored balance of compliance and porosity which is not possible in conventional medical braids.

Oxford Endovascular Ltd an U.K based company is developing the next generation Flow Diverter i.e. Oxiflow which makes use of special laser-cut metal alloy which has a shape-memory property, for the minimally invasive treatment of intracranial aneurysms preventing death or disability due to brain hemorrhage. The human clinical trials are expected to start by 2018 and with CE approval and commercialization by 2021 which would further boost the market for flow diverter.

For research, government funding is an important criterion and apart from government funding many private companies and global leaders are contributing the funds for research and development of neurovascular intervention devices. For instance, in 2018 Perflow Medical received $12 million funding which is used for commercialization of product in Europe and selected countries, for FDA approval in U.S. and fund will also support the development of two products with cerebral net technology platform for aneurysm neck bridging and flow diversion. Hence funding for research and development will create opportunities to innovate new technologies in cardiac assist device market and advanced technologies and upcoming product launches would further boost the this market

The major players operating in Neurovascular Intervention Device market include Stryker Corporation (U.S.), Medtronic Plc (Ireland), Terumo Corporation (Japan), Balt Extrusion (Blockade Medical, LLC) (France), Penumbra, Inc. (U.S.), Johnson & Johnson (U.S.), Acandis GmbH (Germany), Microport Scientific Corporation (China), Phenox GmbH (Germany), Penumbra Inc (U.S.), Abbott Laboratories (U.S.), InspireMD (Israel), Boston Scientific Corporation (U.S.) and Cardinal Health (Cordis Corporation) (U.S.).

Some of the other emerging companies operating in Neurovascular Intervention Device global market include Merlin MD Pte. Ltd. (Singapore), Perflow Medical Ltd (Israel), W. L. Gore & Associates, Inc (U.S.), Rapid Medical (Germany), Allium Medical (Israel), Silk Road Medical (U.S.), Balton Sp. z o.o. (Poland), Asahi Intecc Co., Ltd. (Japan), Evasc Medical Systems (Canada) and other companies.

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