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December 2, 2008 -- 20:20 EST

Volcano Corporation: Intravascular Imaging Ascending

Paul Yock, MD

    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.

Volcano stock for past 6 months

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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