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Next-Generation Coronary Stent Start-Ups: Making a Difference in a Mature Market

Which kinds of innovations make for incremental enhancements in the hands of large companies and which are meaningful enough to sustain a venture-backed start-up company? In a mature market for coronary stents dominated by large companies, start-ups developing new stents need to find the answers. Areas of innovation fall into four basic categories: improving stent safety and biocompatibility, avoiding the need for dual antiplatelet therapy, enhancing deliverability, and introducing specialty stents for complex vessels. Three companies profiled here have a plan for taking sufficient market share, reducing risk, and rewarding investors.

In the drug-eluting stent industry, large companies overturned the innovation paradigm, developing revolutionary new products on their own and leaving small companies--usually the medical device industry's source of innovation--on the sidelines. In 2008, four large companies held the lion's share of a $4.2 billion worldwide market for drug-eluting stents, with, according to recent estimates, Boston Scientific Corp. holding a 49% share of the US market, newest entrant Abbott Laboratories Inc. coming up fast with a 27% share, and Johnson & Johnson and Medtronic PLC each taking 12% portions of the pie. (For a comprehensive discussion of the state of the drug-eluting stent industry, see the recent article, "The Future of Drug-Eluting Stents, Part I: Novel Next-Generation Designs," Medtech Insight, November 2009 Also see "The Future of Drug-Eluting Stents Part I: Novel Next-Generation Designs" - Medtech Insight, 1 November, 2009..)

Start-up companies have tried to take back their rightful place as innovators over the years: early on, by trying to specialize in things large medical device companies weren't good at,...

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