The total coronary stent market comprises bare-metal stents, drug-eluting stents, covered stents, and bifurcated stents. Stents can be defined as small mesh tubes inserted into an artery to prevent it from collapsing and keep it open after an angioplasty surgery (percutaneous coronary intervention, or PCI). Following multiple clinical studies that presented evidence of over-stenting in the U.S market, the value of the overall market has decreased through 2019 and is expected to trend downwards over the coming years, outside of COVID-19-related fluctuations. We have identified the different types of stents and analyzed their benefits and draw-backs:
Top Companies for Coronary Stents by Market Share
1. Boston Scientific – The leading competitor in the coronary stent market was Boston Scientific. Most of the company’s success can be attributed to its strong position in the drug-eluting stents (DES) market, where it held the leading share.
The company currently offers the SYNERGY™ and REBEL™ BMS product line. SYNERGY™ is the first and only FDA-approved DES with abluminal bioabsorbable polymer coating available in the U.S. coronary stent market. REBEL™ is made of a platinum chromium alloy, which is designed to reduce device usage, procedure times, and radiation exposure.
2. Medtronic – Medtronic is the second-leading competitor and maintained a notable position in both the bare-metal stents (BMS) and drug-eluting stents (DES) markets. Through strategic acquisitions and aggressive bundling, Medtronic has increased its share across the interventional cardiology market in recent years.
The company currently offers the Resolute Onyx™ and Resolute Integrity™ DES product lines, as well as the Integrity™ BMS product line. Unlike Boston Scientific and Abbott’s DES devices, which use the everolimus drug, Medtronic’s DES devices use zotarolimus.
3. Abbott – Abbott is the third-leading competitor in the coronary stent market. Competition between Abbott and Medtronic has increased within the DES market, resulting in Abbott losing share in recent years.
The company currently offers the XIENCE™ and Multi-Link Vision™ product lines. Multi-Link Vision™ has been the leading BMS in the U.S. since its introduction. It is constructed of a cobalt-chromium alloy that is more radiopaque than stainless steel stents. This alloy is also stronger than stainless steel, which allows stent construction to be much thinner while still retaining its strength.
Coronary Stent Market Trends – By Type
1. Drug-eluting stents (DES) – All stents have a risk that scar tissue will form and narrow the artery again. This scar tissue can block blood flow. However, drug-eluting stents are coated with drugs that prevent scar tissue from growing into the artery. DES are used for an overwhelming majority of stenting procedures, due to the continued publication of clinical studies supporting their safety and efficacy as the gold standard for stenting procedures. With this clinical backing, the DES market sits at over $1 billion.
However, due to increased bundling and competitive pricing, significant ASP depreciation resulted in negative market value growth in 2019. Negative to flat growth is expected to continue for most of the next few years.
2. Bare-metal stents (BMS) – “Bare-metal stents are mesh-like tubes of thin wire without a coating or covering. Ideally, bare-metal stents will be covered by a new layer of endothelial cells, sealing it into the vessel wall, within a few weeks after implant.” – DAIC.
Bare-metal stents were once the gold-standard choice for stenting procedures but have lost substantial share to drug-eluting stents. It is expected that the segment will continue to contract in market value in the upcoming years with decline rates in the double-digits.
3. Covered stents – Covered stents are composed of fabric or graft material, such as polytetrafluoroethylene (PTFE), covering a metal stent. These devices are seldom used and are indicated for the treatment of free perforations of native coronary arteries or saphenous vein grafts, which would have been treated with a coronary artery bypass graft (CABG) procedure in the past.
The incidence rate of coronary perforation has historically been low. It is estimated to occur in less than 1% of percutaneous coronary intervention (PCI) procedures performed in the United States.
4. Bifurcated stents – Bifurcated stents represent a small fraction of the total market value. Tryton Medical’s TRYTON® Side Branch was the first dedicated bifurcated stent to be approved in the U.S. market, in March 2017.
The segment was once expected to experience very rapid growth, due to the strategic alliance between Tryton and Cardinal Health. However, after the first year on the market, unit sales declined sharply, due to a lack of clinical studies for and efficacy of the stents.
Coronary Stent Market Analysis and Forecast
Overall, the U.S. Coronary Stent market size was valued at over $1 billion in 2020. This is not expected to increase by much over the next few years, as the market observed a loss of 22% resulting from the impacts of COVID19. This is expected to bounce back with growth over the next 2 years but then drop off again as stents become less used in surgeries.
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