Bolt Deal Sparks Boston Scientific vs. Johnson & Johnson ShowdownBolt Deal Sparks Boston Scientific vs. Johnson & Johnson Showdown

Johnson & Johnson sent shockwaves through the cardiovascular intervention market last year with its $13.1 billion acquisition of Shockwave Medical, which now dominates the intravascular lithotripsy (IVL) space. Now, Boston Scientific is charging ahead with plans to acquire Bolt Medical, putting the company in direct competition with J&J for IVL market share.

The deal comes as no surprise because Boston Scientific has been a strategic investor in Carlsbad, CA-based Bolt Medical since 2019 and has an existing equity stake of about 26%. This morning, Boston Scientific agreed to acquire the company with an upfront payment of roughly $443 million and up to $221 million based on the achievement of certain regulatory milestones. All together, this makes the transaction price about $600 million up front and up to $300 million in contingent payments. The deal is expected to close in the first half of the year.

Lithotripsy is a procedure in which a physician breaks up hardened masses such as calcium to help restore blood flow. The Bolt IVL system is designed with a novel application of lithotripsy to fracture calcium by creating acoustic pressure waves inside of a balloon catheter. The system also includes visible, directional emitters for consistent energy delivery in the treatment of the calcified lesions. Boston Scientific said it initially developed the concept for the Bolt IVL system which helped establish Bolt Medical in 2019. 

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Bolt Medical recently announced the completion and results of the RESTORE ATK and RESTORE BTK pivotal clinical trials investigating the Bolt IVL above the knee (ATK) and below the knee (BTK) systems for the treatment of peripheral artery disease in patients with moderate to severely calcified lesions. The data from both studies will be used to support FDA and CE mark regulatory submissions for the devices, the company noted. In December 2024, Bolt Medical received FDA approval to begin the global FRACTURE IDE clinical trial in the United States, which is investigating the use of the Bolt IVL system for the treatment of coronary arterial disease with severely calcified lesions.

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Marie Thibault, a medtech analyst at BTIG and a former MD+DI managing editor, wrote in a report Wednesday that Bolt's IVL technology "fits neatly" into Boston Scientific's portfolio of therapies for peripheral and coronary artery disease, including complex percutaneous coronary intervention products, imaging, and drug-eluting stents and balloons.

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"This acquisition marks [Boston Scientific's] official entry into the IVL market and offers a path toward its 2024 acquisition of Shockwave Medical," Thibault wrote. "We think this is the right move for [Boston Scientific] and continue to see the company as forward-thinking on innovation across its cardiovascular portfolio."

The analyst noted that Boston Scientific also has internal R&D efforts or bets in its venture pipeline on other "buzzy areas" such as left ventricular circulatory support, renal denervation, heart valve repair/replacement, and the shunt space.

Mike Matson, a medtech analyst at Needham & Co., noted in his report on the news that there is an estimated $8.5 billion total addressable market for IVL. Matson agreed that the acquisition is a good fit for Boston Scientific, but he raised some concern about potential litigation from J&J after the deal closes.

"While several of [J&J's] key Shockwave patents were previously invalidated following an inter partes review (IPR), we think there is still a risk that [J&J} uses other Shockwave patents to file a patent infringement suit against [Boston Scientific] upon commercialization of the Bolt Medical IVL system," Matson wrote.

Medtech M&A is off to a strong start in 2025

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Today's news of Boston Scientific's pending acquisition of Bolt Medical follows news earlier this week that Stryker plans to acquire Inari Medical Inari Medical in a deal valued at $4.9 billion.

While M&A activity did tick up a bit in 2024, that was compared to a sluggish M&A year in 2023 and was still below norms, EY's John Babitt told MD+DI Editor-in-Chief Omar Ford in October on the Let's Talk Medtech podcast.

Given that we've already seen two meaningful M&A announcements in the first half of January, we're optimistic for an even stronger medtech M&A environment in 2025.

"We are pleased to see the flurry of 2025 medtech M&A continue following Stryker's ... announcement to acquire Inari Medical ... earlier this week," BTIG's Thibault noted.