The European neurovascular device market is a growing industry driven by the projected increase in stroke and cerebral aneurysms.
In recent years, there has been a transition from surgical techniques to endovascular techniques in interventional neuroradiology. This resulted in a transformation from aneurysm clipping to endovascular coiling and, more recently, flow-diverting and intrasaccular stents. For many years, the gold standard treatment for strokes has been a clot-dissolving or blood-thinning drug called tissue plasminogen activator (tPA). New technologies, such as stent retrievers and aspiration catheters, offer a longer duration of treatment after the onset of symptoms and may improve clinical outcomes when used in conjunction with tPA.
This shift in the treatment of stroke and cerebral aneurysm has resulted in significant market growth in the affected markets, which is projected to continue to grow as newer and more technologically advanced devices become more widespread in the medical community.
Strokes
The neurovascular thrombectomy market will experience steady moderate market growth during the forecast period, driven by increased unit sales as thrombectomy devices are adopted as the standard of care for acute ischemic stroke patients.
Ischemic stroke requires immediate treatment. The main goal of treatment is to reduce brain damage by restoring blood flow and clearing the blockage very quickly. Treatment options include tissue plasminogen activator (tPA) drugs and mechanical thrombectomy.
The thrombectomy market includes stent retrievers and aspiration catheters. In most cases, a combination of the two categories is used, but many factors can influence treatment decisions, such as physician preference, anatomy, and location of the clot. Studies have shown that the new stent retriever devices have similar efficacy to the latest generation aspiration catheters. Further clinical trials will influence whether the devices continue to be used together or whether one category cannibalizes shares from the other.
Compared to other neurovascular markets, the thrombectomy market varies significantly by country in terms of device usage and year-over-year growth. For example, in 2022 the German market was about seven times larger than the UK market, with Spain, France and Italy somewhere in the middle. Many countries are not adequately addressing the demand for thrombectomy treatments. A 2019 report by the British Association of Stroke Physicians (BASP), for example, stated that there was a “worrying” shortage of stroke specialists and that the number needed to be increased by at least a third to meet patient demand. The large addressable population, which is similar in other European countries, will drive the growth of the market with procedural growth.
The impact of COVID-19 on the thrombectomy market varies by country. Overall, the European market as a whole saw only a moderate decline in 2020 and will fully recover in 2022.
Brain aneurysms
A cerebral aneurysm is a localized dilation of a blood vessel in a cerebral artery or vein. An aneurysm is a weakened area in the wall of an artery in the brain. This area bulges in the artery, and if it ruptures, it can lead to bleeding in the brain and cause stroke, brain damage, and even death. A brain aneurysm usually has no symptoms or signs.
Interventional neuroradiologists commonly perform the detachable coil embolization procedure to mitigate the dangers associated with aneurysms. An unruptured aneurysm can only be detected during tests, such as during angiographic imaging. Emergency treatment for ruptured aneurysms involves restoring normal blood flow to the brain and reducing intracranial pressure. Treatment options include surgical excision and endovascular coiling. Flow-diverting and intrasaccular stents offer another treatment alternative for large aneurysms.
Aneurysm clips
The neurosurgical clipping procedure consists of a specially designed clip and is usually performed through a craniotomy to access and close the aneurysm. In most cases, the aneurysm itself is clipped; in some complicated cases, the artery itself must be cut.
The aneurysm clips market is projected to decline slightly during the forecast period. As European countries continue to adopt endovascular coiling procedures, the use of aneurysm clips will decline in this saturated market. However, aneurysm clips cannot completely replace coiling, as clips have been shown to reduce recurrence rates and have greater efficacy in certain circumstances.
The aneurysm clip market has not been as severely affected by the COVID-19 pandemic as other neurovascular markets. One danger of COVID-19 is that it increases the likelihood of rupture of arteriovenous malformations (AVMs), which are treated with temporary clips.
Manufacturers of second- and third-generation aneurysm clips in the US and European markets are replacing chrome-cobalt clips with titanium because the material offers superior safety and is compatible with magnetic resonance imaging (MRI). However, titanium clips require a higher ASP than other alloy clips.
Removable rolls
Endovascular coiling or coil embolization procedures involve endovascular insertion of coils to block blood flow and fill aneurysms. A small incision is made near the patient’s groin to insert the catheter, which is then guided through the circulatory system to the aneurysm. Coils are inserted through the catheter to fill the aneurysm, and the body responds by forming a blood clot around the coil, thereby strengthening its position. Coils must strike a balance between softness and stiffness so that the coil avoids rupturing the aneurysm wall but does not migrate out of the aneurysm.
The decrease in the market value of the coils is therefore caused on the one hand by the lower unit sales, and on the other hand by the decrease in prices, as a result of the shift away from the use of coated coils. A 2019 study suggests that fiber coils have convincingly shown a huge difference in acute occlusion compared to non-fiber coils, but it will be several years before this speculative technology is indicated in neurological applications and adopted in the coil market.
Unit sales of coils are threatened by new technologies such as flow diverters or intrasaccular devices that cannibalize aneurysm treatment procedures. As more aneurysms are treated with new technology and the remaining ones use fewer coils, unit sales will decline.
Flow-diverting and intrasaccular stents
A rapidly growing alternative for the treatment of large aneurysms is the use of flow-diverting and intrasaccular stents. These devices work by restoring the original, natural blood circulation in the artery, allowing stagnant blood within the lesion to clot and create a permanent, long-term blockage. These innovative devices aim to gain market share from aneurysm clips, detachable coils and traditional stents.
Flow-diverting stents have grown rapidly in Europe over the past 15 years and are now used to treat the majority of large aneurysms for which the device is indicated. As technology advances, these devices may gain more market share from competing devices if they are indicated for smaller aneurysms. However, these devices themselves will experience cannibalization when new products in the pipeline are approved for aneurysm treatment, such as intrasaccular stents.
There are currently two brands of intrasaccular stents offered on the European market; MicroVention WEB™ device and Cerus Endovascular’s Contour neurovascular system. These technologies are just beginning to become legitimate contenders in the aneurysm embolization market, so depending on international adoption rates and changes in reimbursement policies, there is potential for huge market growth. One WEB™ device can cost five times as much as a set of embolization coils, where countries are unwilling to reimburse hospitals more than the cost of established embolization techniques. This situation has resulted in a decrease in the device’s ASP as it becomes more popular in many countries such as Germany, France and the UK. Despite the decline in ASP, unit sales are growing rapidly year over year, which is expected to be the market for intrasaccular stents. with significant growth in leaps and bounds in 2022.
Final thoughts
The overall neurological devices market is expected to grow by more than 40% by the end of the forecast period at a mid-single-digit CAGR. This growth is fueled by an aging demographic, growth in neurological procedures, and extensive technological advancements, particularly in the stroke treatment markets.
While this article focuses on the neurovascular device market, iData Research’s European Neurological Devices Report includes in-depth market analysis of neuromodulation devices, CSF management, ultrasonic aspirators, and more.
About the Authors
John Fraser analyst group leader at iData Research. Develops and produces syndicated and unique research projects related to the medical device industry, publishing the European Neurological Devices Market Research Report.
Kamran ZamanianPh.D., CEO and founding partner of iData Research. He has spent more than 20 years in the market research industry studying medical devices used for patient health around the world.
About iData Research
For 19 years, iData Research has been a strong advocate for data-driven decision-making in the global medical device, dental and pharmaceutical industries. With unique research and consulting solutions, iData enables its clients to trust the data source and make important strategic decisions with confidence.