Physician Forum

December 2011

Drug-Eluting Balloons: Emerging Opportunities in Interventional Cardiology Treatment in Europe

Introduction:

Millennium Research Group’s new Physician Forum study investigates physician perceptions of drug-eluting balloons for use in coronary revascularization treatment. With an aging population and unhealthy lifestyles, coronary artery disease (CAD) is on the rise in most developed nations. Revascularization options include balloon angioplasty, stenting, and atherectomy. Restenosis is a recurring problem in many patients, even when lesions are treated with drug-eluting stents (DES). The use of a drug, delivered to the target lesion through a stent or balloon, is meant to hinder new cell growth and hence restenosis within the vessel. The use of DES has become associated with lower rates of restenosis but higher rates of thrombosis, which is attributed for the most part to the polymer that binds the drug to the stent. While DES were generating a lot of excitement, some manufacturers began to develop drug-eluting balloons for the treatment of coronary and peripheral artery disease. There are now as many as seven manufacturers marketing drug-eluting balloons in Europe, with at least one more company with a drug-eluting balloon in its pipeline. Drug-eluting balloons have been marketed as an alternative to DES, in particular for patients who require treatment for in-stent restenosis (ISR), bifurcation lesions, small vessels, and chronic total occlusions (CTOs). Essentially, drug-eluting balloons are considered an ideal treatment for lesions that are prone to high restenosis and ISR, or for those lesions or patients that cannot be treated with DES. This new publication looks at European physician opinions of drug-eluting balloons used for coronary revascularization procedures, both from a current user and potential adopter (nonuser) perspective.

Scope:

What Questions Will Physician Forum Help You Answer?

  • Which countries are adopting drug-eluting balloons more readily and why?
  • What is the potential for drug-eluting balloons and to what extent will the increasing volume of clinical data impact physicians' use of drug-eluting balloons?
  • What patient/lesion types are most likely to be treated with a drug-eluting balloon?
  • What are the barriers to drug-eluting balloon adoption?
  • Will drug-eluting balloons be used with or without stents, and what does this mean for the future of bare-metal stents (BMS) and DES?
  • How often do physicians pre-dilate the lesion when using a drug-eluting balloon, and what devices do they use?
  • What are physician perceptions of drug diffusion, residence, and transfer?
  • How do physician impressions of drug-eluting balloons compare with those of bioabsorbable scaffolds?
  • What are physician perceptions and preferences of currently available drug-eluting balloon brands?

Key Sections: The following is an overview of the structure of the publication. The full publication contains 98 slides.

  • Executive Summary
    • Key Findings
    • Introduction
    • Commercial Context
  • Methodology
    • Terminology
    • Scope
    • Survey Design
    • Specialty Analysis
    • Place of Practice
    • User and Nonuser Distribution
    • Procedure Volumes
  • Analysis of Survey Results
    • Current Practice Patterns and Perceptions of Drug-Eluting Balloons
      • Benefits and Assumptions about Drug-Eluting Balloons
        • Benefits of Using Drug-Eluting Balloons in Coronary Procedures
        • Factors Preventing the Use of Drug-Eluting Balloons in Coronary Interventions, by Country
        • Technology Ratings for Treating Coronary Artery Disease, by Technology
        • Desired Content of Drug-Eluting Balloon Clinical Trials
        • Desired Structure of Drug-Eluting Balloon Clinical Trials
        • Necessity for Dual Antiplatelet Therapy (DAPT) Following Drug-Eluting Balloon Treatment
        • Frequency of Pre-Dilation, by Country
        • Potential for Drug-Eluting Balloons, by Segment
        • Potential for Drug-Eluting Balloons, by Country
      • Current Drug-Eluting Balloon Use
        • Drug-Eluting Balloon Penetration, by Country
        • Distribution of Drug-Eluting Balloon Users, by Volume and Country
        • Percutaneous Coronary Transluminal Angioplasty (PTCA) Procedures, by Device Type and Country
        • PTCA Procedures, by Device Type and by Vessel/Patient Type
      • Drug-Eluting Balloons with Stents
        • Use of Drug-Eluting Balloons with/without Stent, by Vessel/Patient Type
        • Use of Drug-Eluting Balloons with/without Stent, by Country
        • Use of Drug-Eluting Balloons with/without DES and BMS, by Vessel/Patient Type
        • Use of Drug-Eluting Balloons with/without DES and BMS, by Country
        • Physician Views on Using Drug-Eluting Balloons with DES
        • Theoretical Use of Drug-Eluting Balloons with/without Stent, by Vessel/Patient Type
        • Theoretical Use of Drug-Eluting Balloons with DES/BMS/without Stent, by Vessel/Patient Type
        • Why Physicians use a Drug-Eluting Balloon and a DES in the Same Procedure
        • User Views of Device Deployment
        • Nonuser Views of Device Deployment
      • Drug Delivery
        • Opinions on Paclitaxel use in Drug-Eluting Balloons for the Treatment of Coronary Artery Disease, by Segment
        • Opinions on Paclitaxel use in Drug-Eluting Balloons for the Treatment of Coronary Artery Disease, by Country
        • Concerns about Paclitaxel Use in Drug-Eluting Balloons
        • Level of Agreement/Disagreement Relating to Drug-Eluting Balloon Drug Transfer, by Segment
        • Level of Agreement/Disagreement Relating to Drug-Eluting Balloon Drug Transfer, by Country
        • Opinions on Rate of Drug Diffusion, by Segment
        • Opinions on Duration of Drug Residence, by Segment
      • Drug-Eluting Balloon Pricing
        • Price Premium for a Drug-Eluting Balloon Compared to a DES
        • Price Premium for a Drug-Eluting Balloon Compared to a PTCA Balloon
        • Opinions on Prohibitive Cost of Drug-Eluting Balloons, by Country
        • Factors Contributing to Prohibitive Cost of Drug-Eluting Balloons, by Country
    • Brand Awareness and Perceptions
        • Familiarity with Drug-Eluting Balloon Products, by Brand
        • Currently Used Drug-Eluting Balloon Products, by Brand and Country
        • Currently Used Drug-Eluting Balloon Products, by Brand and Vessel/Patient Type
        • Preferred Drug-Eluting Balloon Products, by Brand and Country
        • Retention Ratio, by Brand
        • Clinical Evidence of Drug-Eluting Balloons for Coronary Artery Disease, by Brand
        • Efficacy of Drug-Eluting Balloons for Coronary Artery Disease, by Brand
        • Safety of Drug-Eluting Balloons for Coronary Artery Disease, by Brand
        • Deliverability of Drug-Eluting Balloons for Coronary Artery Disease, by Brand
        • Overall Impression of Drug-Eluting Balloon Products, by Brand
        • Requirement to Try Drug-Eluting Balloon Products, by Brand
    • Future Practice Patterns
        • Change in Drug-Eluting Balloon Usage in the Next 12 Months, by Country
        • Factors Resulting in Stable Drug-Eluting Balloon Usage, by Country
        • Factors Increasing Drug-Eluting Balloon Usage, by Country (Users)
        • Intention to Adopt Drug-Eluting Balloons, by Country
        • Factors Increasing Drug-Eluting Balloon Usage, by Country (Nonusers)
        • Factors Increasing Drug-Eluting Balloon Usage, by Segment and Specialty (Combined Sample)
        • Drug-Eluting Balloon Usage, by Vessel/Patient Type (Nonusers)
        • Effect on Treatment Rate of Drug-Eluting Balloons if Available for Small Vessels, by Country
        • Rate of Increased Drug-Eluting Balloon Treatment of Small Vessels if Available, by Country
        • Drug-Eluting Balloon Usage, by Vessel/Patient Type (Combined Sample)
        • Drug-Eluting Balloon Usage, by Vessel/Patient Type (Interventional Cardiologists)
        • Respondents Unwilling to Adopt Drug-Eluting Balloons for Coronary Interventions
        • Anticipated Future Drug-Eluting Balloon Penetration, by Country
        • Anticipated Future Penetration of Drug-Eluting Balloons, Bifurcations, by Country
        • Anticipated Future Penetration of Drug-Eluting Balloons, In-stent Restenosis, by Country
        • Anticipated Future Penetration of Drug-Eluting Balloons, Simple de Novo, by Country
        • Anticipated Future Penetration of Drug-Eluting Balloons, Small Vessel 2.5 mm and Smaller, by Country
        • Future Drug-Eluting Balloon with Stent Usage (12 Months), by Vessel/Patient Type
        • Future Drug-Eluting Balloon with Stent Usage (3 Years), by Vessel/Patient Type
        • Opportunities for Drug-Eluting Balloons Compared with Drug-Eluting Bioabsorbable Stents, by Segment
        • Ideal Applications for Drug-Eluting Balloons, by Country
        • Ideal Applications for Bioabsorbable Scaffolds, by Country
  • More on MRG
  • Appendix
    • Select Country-Specific and Detailed Question Results

Methodology: This survey was designed by Millennium Research Group analysts with expertise in the cardiovascular market.

  • The survey was conducted in two parts: the first part in May 2011 and the second part in October 2011.
  • Respondents were recruited through a third-party recruiting company. Respondents were invited to participate through e-mail, and the survey was administered online.
  • Respondents were controlled for regional distribution and experience level.
  • The study includes two separate surveys of current users and potential adopters (Nonusers) of drug-eluting balloons.
  • Current Users (n = 146):
    • Have used a drug-eluting balloon in coronary revascularization procedures over the past 6 months
    • Composition
      • 115 Interventional Cardiologists
      • 31 Other Physicians (Cardiac Surgeons, General Surgeons, Interventional Radiologists, and Vascular Surgeons)
      • 28 France
      • 35 Germany
      • 27 Italy
      • 26 Spain
      • 30 UK
  • Nonusers (n = 50):
    • Have not performed a percutaneous coronary transluminal angioplasty procedure with a drug-eluting balloon in the past 6 months
    • Composition
      • 44 Interventional Cardiologists
      • 6 Other Physicians (Cardiac Surgeons, General Surgeons, Interventional Radiologists, and Vascular Surgeons)
      • 11 France
      • 4 Germany
      • 17 Italy
      • 7 Spain
      • 11 UK

Authors:

Karene Dumoulin

Contact Sales:

Phone: 1-416-364-7776

E-mail: sales@mrg.net



Search Reports

Mentioned in this report:

  • Aachen Resonance
  • Abbott Vascular
  • B. Braun
  • BIOTRONIK
  • Blue Medical
  • Eurocor
  • Invatec/Medtronic
  • Minvasys
Decision Resources Group brands include: