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December
2,
2008 -- 20:20 EST
Volcano Corporation: Intravascular Imaging Ascending
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Over
two decades ago, I sat in an office at UCSF with Dr. Paul Yock,
discussing his latest invention: intravascular ultrasound (a.k.a
IVUS). I was working with him and his partner, Dr. Peter Fitzgerald,
on a training video, teaching cardiologists how to interpret
the images of this new and unheard of technology. |
It was the mid-80's, and I, optimist that I was/am, was
certain that this new way of visualizing the interior of the coronary
artery would lead to a breakthrough in treatment. My opinion was
validated -- it just took a couple of decades....
The product, at that time manufactured
and marketed by a company named CVIS, was ultimately acquired by
Boston Scientific. A competing IVUS technology was developed by
Endosonics, which
was purchased
by
Jomed, and which ultimately was acquired by Volcano Corporation.
So, today in
2008,
we have a duopoly in the IVUS field: Volcano and Boston Scientific.
But, while Boston Scientific has a wide-ranging array
of medical devices, from stents to ICDs, Volcano has concentrated
solely on the development and implementation of intravascular technologies,
such as IVUS, Fractional Flow Reserve (FFR), OCT, VH-IVUS and forward-looking
IVUS. And to
Volcano's credit, the two currently-approved areas, IVUS and FFR,
are proving to be not just helpful adjuncts
to percutaneous interventions, but critical tools to improving
outcomes. And subsequently, profit centers for the company.
A quick look at this recent history of stock prices
tells part of the story. Compared to its price six months ago, Volcano
actually has increased its value by 19% -- this, in the midst
of the worst economic meltdown since the Depression. Meanwhile, the
four major stent manufacturers have suffered significant downturns,
the worst being
Volcano's chief competitor, Boston Scientific.
There are a number of reasons why Volcano has been performing
so well -- many of them business decisions that we will not get into
here. But the interesting facts for patients are that a technology
that allows cardiologists to see and measure inside of the
artery (IVUS) provides for more accurate stent placement and expansion,
and theoretically lower rates of stent thrombosis.
And being able to
measure the specific
blood pressure passing through a suspected arterial blockage (FFR)
provides data for an informed treatment decision: is this blockage
causing ischemia or not?
(The
recent FAME study showed quite dramatically that using FFR significantly
improved patient outcomes by eliminating unnecessary stent placement.)
Professional interest in these technologies is at an
all-time high -- at the recent TCT meeting in Washington, Volcano's
evening symposium on IVUS and related technologies attracted the
largest number of registrants of any evening meeting.
The whole field of intravascular imaging is an exciting one. Current technologies
can help target therapies for the greatest benefit. Future technologies
may marry treatment with observation, opening up a new era of interventional
cardiology.
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