European Markets for Percutaneous Transluminal Coronary Angioplasty and Coronary Stenting Products

The most common cause of death in Europe is coronary heart disease (CHD), a form of cardiovascular disease in which the flow of blood through one or more of the arteries in the heart is impeded due to atherosclerotic plaque accumulation on the inner walls of the affected vessels. Coronary heart disease is responsible for more than 1.9 million deaths in Europe each year, accounting for 21.0% of deaths in men and 22.2% of deaths in women. In the 27 member countries comprising the European Union (EU), CHD accounts for approximately 741,833 deaths annually, with 16.0% and 14.8% of deaths in men and women attributable to the disease, respectively.

Treatments for CHD range from lifestyle changes and noninvasive medical therapies to open surgical and interventional revascularization methods. Introduced in 1977 (but not becoming widely used until the mid-1980s), percutaneous transluminal coronary angioplasty (PTCA) has become the basic interventional modality used for the nonsurgical revascularization of plaque-blocked arteries in the heart. Typically less traumatic to patients than open surgery, PTCA is used in both elective and emergent percutaneous coronary intervention (PCI) procedures, and most often is performed in conjunction with stenting.

The development of coronary stents—tiny balloon-expandable or self-expanding scaffolds that are placed within narrowed arteries in the heart to maintain/restore vessel patency—revolutionized catheter-based interventions for CHD worldwide. Not only are coronary stents effective in reducing the rate of restenosis and other complications associated with PTCA, they also have proven useful as a direct interventional therapy (e.g., for treating short, first-time lesions in large arteries and for opening occluded bypass grafts).

Over the past two decades, coronary stenting has become the primary interventional modality used for the treatment of CHD in Europe, and is expected to remain the dominant method employed for the non-medical management of advanced CHD throughout the forecast period covered by this report. Europe, for the forecasting purposes of this report, consists of the nations of France, Germany, Italy, Spain, the United Kingdom (U.K.), and the Benelux countries of Belgium, the Netherlands, and Luxembourg.

During the forecast period covered by this report, a growing number of patients in Europe will undergo PCI procedures due to a combination of factors including changing demographics in the region (with expansion in many countries’ eldersegment and total populations), and the recent rebound in coronary stenting procedure volumes (as safety concerns involving drug-eluting stent [DES] implantation are addressed, and coronary stenting and chronic total occlusion crossing technologies continue to improve). Other factors positively affecting overall PCI procedure volumes in Europe include the increase in the number of dedicated PCI centers, and the growing use of primary PCI in place of thrombolysis in the treatment of ST-elevation myocardial infarction (STEMI) patients; examples include the U.K., where primary PCI cases grew (at the expense of thrombolytic therapy cases) from approximately 3,930 in 2006 to 9,224 in 2008, and Italy, where the number of these types of cases increased from approximately 20,003 to 24,101 during this same period. In addition, the recent introduction of drug-eluting balloon (DEB) angioplasty in Europe is expected to boost PTCA procedure volumes as the DEB devices are utilized by physicians in a range of patients including those for whom late-stent thrombosis (LST) and long-term antiplatelet therapy compliance issues are a concern.

It is projected that the total number of PTCA/coronary stenting procedures performed in Europe will grow at a compound annual rate of 3.5% during the next half-decade, increasing from an estimated 778,888 in 2009 to approximately 923,853 in the year 2014. Total PTCA/coronary stenting procedure volumes were estimated at 276,501 in Germany in 2009, followed in order by France with 143,389, Italy with 135,365, the U.K. with 83,705, the Benelux countries with 76,264, and Spain with 63,664. In the year 2014, it is expected that Germany will continue to lead the region in the total number of PTCA/coronary stenting procedures with approximately 326,728, followed in order by France with 168,780, Italy with 162,168, the U.K. with 101,849, the Benelux countries with 88,206, and Spain with 76,122.

Products used to perform PTCA and coronary stenting procedures include balloon angioplasty catheters (conventional and drug-eluting), coronary stenting systems, guiding catheters, guidewires, introducers/sheaths, inflation devices, and vascular access site closure devices. 

It is projected that the combined European market for PTCA and coronary stenting systems will grow at a compound annual rate of 5.1% during the next half-decade, increasing from approximately $1,876.9 million in 2009 to an estimated $2,404.4 million in the year 2014. Total sales of PTCA devices and coronary stenting systems were estimated at $596.9 million in Germany in 2009, followed in order by Italy with $370.4 million, France with $363.2 million, Spain with $197.9 million, the Benelux countries with $176.5 million, and the U.K. with $171.8 million. In the year 2014, it is expected that Germany will continue to lead the region with approximately $764.0 million in the total sales of PTCA devices and coronary stenting systems, followed in order by Italy with $481.9 million, France with $461.8 million, Spain with $252.2 million, the U.K. with $225.2 million, the Benelux countries with $219.2 million.