Over the past several years, there has been a transition in interventional neuroradiology from using surgical methods to adopting endovascular techniques. This has brought a conversion from previously used aneurysm clipping to greater incidences of endovascular coiling.
|The detachable coil market, shown here by segment, continues to grow exponentially in India.|
Coils are used to treat aneurysms and fistulas in the brain in order to prevent rupture. They help to stop the flow of blood into the aneurysm sac, reducing the likelihood of rupture to the aneurysm.
A brain aneurysm occurs when there is internal bleeding, which may result in a stroke. Detachable coil embolization is used to treat brain aneurysms as well as brain blood vessel malformations.
Aneurysm Repairs Expected to Increase with Aging Indian Population
Interventional neuroradiologists typically perform a detachable coil embolization process to alleviate dangers associated with aneurysms. The coils are used to block blood flow or fill the aneurysm. Aneurysm repairs are expected to increase with the aging Indian population.
According to the Brain Aneurysm Foundation, there is a high prevalence of cerebral aneurysms among elderly citizens. The median age for an aneurismal stroke is 50. Most aneurysms are small, and an estimated 50–80% of all aneurysms do not rupture during a patient’s lifetime. However, brain aneurysms are fatal in about 40% of cases, and 66% of surviving patients suffer some form of permanent neurological damage.
According to the CIA World Factbook, India had an estimated population of 1.2 billion in 2012. About 5.6% of the population was aged 65 years or older. In the future, the number of cerebral aneurysm cases is expected to increase with the growth of the aging population in India.
Last year, more than 1000 endovascular cerebral aneurysm repairs were performed in India, an increase of more than 20% over the previous year. In India, the lack of public advocacy for health has led to low health awareness. Patients often fail to recognize the onset of symptoms of a developing aneurysm; thus the majority of them will already have a large aneurysm by the time they seek medical attention. To prevent aneurysms from rupturing, surgeons in India resort to endovascular repair to ensure successful patient outcomes.
|In India, endovascular aneurysm procedures are rising in conjunction with the aging population.|
The types of endovascular devices used in cerebral aneurysm repairs—such as neurovascular stents, detachable coils, neurovascular catheters, and neurovascular guidewires—depend on the size and shape of the aneurysm. Stent-assisted repairs are performed to target wide-neck aneurysms. Placing the neurovascular stent along with a detachable coil helps anchor the coil in place. Last year, one-fifth of all cerebral aneurysm repairs required neurovascular stents, mainly due to the low incidence of wide-neck aneurysms in India and the higher average selling price of neurovascular stents.
Growth in aneurysm procedures has been influenced by India’s aging population and by competing technologies within the endovascular device market. The number of endovascular cerebral aneurysm repairs in India is expected to increase at a combined average growth rate of more than 20% by 2019.
Growth of the Detachable Coil Market
The Guglielmi detachable coil was first investigated in clinical trials in 1990. Licensed for sale in Europe in 1992, the coils were only used on patients with aneurysms of undesirable size or in a location with limited access.
Clinical results have suggested that coiling is beneficial for some types of patients. It is used when permanent occlusion is the desired outcome. There have been many contentious issues that pertain to treatment recommendations for endovascular coiling, including treatment timing, the incidence of procedural complications, anatomical cure rates, and recurrence.
Because of the disputes over endovascular coiling, the International Subarachnoid Aneurysm Trial (ISAT) was launched. It is the largest reported multicenter prospective randomized control trial, comparing the safety and efficacy of endovascular coil treatment and surgical clipping for the treatment of ruptured brain aneurysms. The ISAT report, which raised concerns about the long-term cure rate of coiling, generated a great deal of controversy. Despite the concerns raised by the ISAT study, patients demonstrated improved short-term outcomes. Thus, many medical professionals have decided that coiling is the preferred method of treatment for patients who fit the ISAT criteria.
Two types of detachable coils are available on the market: bare platinum coils and coated coils. The former represents almost 90% of the market. Bare platinum coils were introduced into the Indian market nearly 20 years ago and have become the gold standard for coils. Due to years of use and an abundance of positive clinical results, use of bare platinum coils is expected to continue to grow. With the rapid introduction and adoption of the newer coils, the Indian detachable coil market is expected to grow at a double-digit combined average growth rate over the next five years.
Terumo Leads the Detachable Coil Market
In 2012, Terumo MicroVention led the market for detachable coils. Tokyo-based Terumo is an international manufacturer of general hospital, cardiac, vascular, and home healthcare products. Its MicroVention subsidiary develops and manufactures minimally invasive devices for the treatment of cerebral and vascular peripheral disease. MicroVention products are distributed in India by Faith Biotech Private Ltd. The company’s MicroPlex coil system consists of framing helical coils for filling and HyperSoft coils for packing the aneurysm. The HydroCoil and HydroSoft coils use hydrogel technology to increase the filling capacity and mechanical stability of the aneurysm.
Stryker is another leading competitor in the detachable coil market. Its GDC 360° detachable coils were the first introduced into the Indian market, and the Matrix detachable coil was the first with a bioabsorbable component. In 2012, Covidien was also a major participant in the market, with its AXIUM, Nexus, and NXT Tetris detachable coils.
Thanks to benefits such as proven efficacy, durability, and acceptability, along with the fact that they are minimally invasive, detachable coils will remain the preferable option for treating cerebral aneurysms endovascularly in India. This market will continue to grow and persist as the most viable treatment option when compared with surgical techniques. However, Covidien’s products, such as Onyx liquid embolics and the Pipeline flow diversion device, are expected to increase aneurysm repair options for surgeons in India, changing the types of endovascular devices used for cerebral aneurysm repair and leading to a potential cannibalization of the detachable coil market.
Kamran Zamanian is president, CEO, and a founding partner of iData Research Inc. (Vancouver, BC). Reach him at firstname.lastname@example.org.
Olivia Fellows is a research coordinator at iData Research. Contact her at email@example.com.