My first Transcatheter Cardiovascular Therapeutics (TCT) conference, which wrapped up this week in San Francisco, was packed with interesting sessions and tons of cool science. I returned from San Francisco with some tchotchkes for my family, some beautiful photos, and lots of food for thought about the changing interventional vascular medtech markets. Here are three main take homes from TCT 2015:
1. Bare metal stents are on the way out.
No less august a figure than Marty Leon said that “BMS are finished” in the wake of the LEADERS FREE trial, which showed superiority of the Biosensors drug-coated stent over the older technology in high-bleeding risk patients, basically the only indication for which BMS are still used. Or, as Marie-Claude Morice put it during the Wednesday evening session, BMS now belong in “the interventional cardiology museum”.
2. Renal denervation is down but not out.
Speaking of Marty Leon, he led a breakfast session on renal denervation. Although well-attended by maybe 80 people, he noted that a few years ago renal denervation would have been in the main arena and would have drawn a crowd more than 10 times the size. Of course, this is all due to the negative results from the SYMPLICITY HTN-3 trial, which showed no effect for the procedure over the sham control. Despite being in a “phase of quiescence”, Leon and the other panelists agreed that there remains cause for hope, with improved devices, techniques (including targeting the distal renal arteries and not just the proximal) and patient selection holding out the possibility of demonstrating the procedure’s effectiveness.
3. Get ready for a Medtronic/C.R. Bard grudge match in the drug-coated balloon market.
One of the hottest topics at the conference of course was the use of DCBs in treating lower-limb ischemia, with multiple sessions on the use of these devices in treating both the SFA and BTK indications. While everyone agrees that DCBs are vastly superior to standard PTA balloons, the other major theme throughout several sessions dedicated to the topic is the lack of a DCB ‘class effect’. Put another way, all DCBs are not created equal (with major differences in terms of the amount of paclitaxel loaded, as well as the excipient used) and most physicians expect different DCBs to perform better than others.
So which of the currently available DCBs is best? Unfortunately, there is no head-to-head randomized data comparing different brands, so there is no way to say for sure. However, it’s been pointed out that Medtronic’s device outperformed the Bard device when one compares across two trials (the IN.PACT and LEVANT studies, respectively). As a similar rate of patency was achieved in the control group in both studies (suggesting the two study populations might be comparable), people are bullish on Medtronic’s prospects for proving superiority. Of course, even if they manage this, they have other competitors to contend with, including Boston Scientific and their Ranger DCB.
Of course, there was lots of other interesting data presented, particularly on the ABSORB clinical trials investigating Abbott’s bioresorbable vascular scaffold, the subject of another blogpost. A great conference overall!
Follow Alexander Marsolais on Twitter at @amarsolais_DRG