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Stent Wars: The Sequel--Is J&J Back?

Executive Summary

While it's far too early to begin talking about a phoenix-like resurgence, Johnson & Johnson shows initial signs of at least shaking up what in recent years has become a far too comfortably stratified coronary stent market. J&J's Cordis Corp. received FDA approval of its new Bx Velocity stent in mid-May, several weeks earlier than anticipated.

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Stents Move Up to the Carotid

Just as drug-eluting stents prevent heart attacks by maintaining the patency of coronary arteries, so do carotid artery stents prevent strokes by keeping carotid arteries open. Carotid artery stenting, like coronary stenting, is a minimally invasive, percutaneous procedure and both procedures use similar kinds of devices. The large cardiovascular device companies are all in clinical trials with carotid artery stents, but none is expected on the US market before 2005. Still, the market for carotids isn't likely to be nearly as big as that of coronary stents.

Beyond Drug-Coated Stents

'Drug-coated stents' success will usher in a new era in interventional cardiology, argues Marty Leon, MD, one of the nation's top interventional cardiologists. He sees interventionalists taking the lead in new areas and expanding their presence in others, such as interventional radiology, and interventional neurology. New nanotechnologies will be used to manufacture stents to ensure better adhesion of therapeutic agents, and these will need new access technologies and imaging systems, for example.

Stent and Deliver

Stents have been very effective at avoiding elastic recoil by mechanically holding arteries open after balloon angioplasty. They have also, to a certain extent, alleviated the problem of restenosis, the reocclusion of the artery in the months following angioplasty. Unfortunately, however, stents don't go far enough to prevent restenosis--anywhere from 10% to 40% of patients will develop restenosis within six months of revascularization procedures--and the devices frequently result in a new, man-made and difficult-to-treat kind of restenosis, known as in-stent restenosis. Thus, device developers are putting serious development effort into enhanced stents that can carry and deliver drugs to combat restenosis locally.

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