This IPO performance was a blockbuster. I caught the news here in Asia and was meaning to post on it (apologies if someone already has).
It came up again today in an investor meeting I had in Singapore.
Anyhow aside from what shockwave is doing and how it has been received, for those in Abiomed - Abiomed took up their option for a $10m stake at the IPO buy in price. They just doubled their money!
Maybe worth keeping an eye out for other Abiomed investments.
A rep came a few months ago to demo their product. It’s the same concept behind ESWL (external ultrasound to break up kidney stones) but mounted on a catheter with a balloon. The concept is that instead of conventional angioplasty for calcified blood vessels you also provide a “shock” to break up the calcium to minimize the amount of pressure used and protect the blood vessel itself. It’s only marketed for peripheral arterial disease (mainly those in the legs) but of course they have people using it in other vessels like those supplying the kidneys, abdomen, etc.
I haven’t had a chance to actually use one in a patient but I might have the rep come by to demo it again if something comes up where I think it might help. The literature always shows a benefit but then again the company designs the trials so I always take those with a large pinch of salt. I’m sure some head to head studies will be done comparing regular balloons to Shock Wave to drug coated balloons etc.
I don’t know whether they are used in the heart, or if the ABMD investment is strictly based on both being in the catheter directed therapy space.
The business model is in theory the same as ABMD. Get doctors to use them, they always reorder, and maybe start using them in more patients. Supposedly they have focused sales on certain regions (I believe the northeast and west coast). When they came by late last year it was the first I’d heard of them, despite staying somewhat up to date with current literature in the field.
I really want to like this concept, and in fact said about 8 years ago that intravascular ultrasound for coronary disease should be a thing to look at plaque stability (long story)…
However they still aren’t in the USA market, and are being first used for peripheral vascular disease in EU… And, well, their results are not yet equal to current standards of care for peripheral vascular disease. We’re at least 4-5 years from this even considering cracking the coronary disease market.
Data in 2-3 years for leg disease. This is dead money and speculative until then.
I think ABMD was thinking more along the lines of PAD when they invested than coronary disease (probably both but more the former). You need open iliac and femoral arteries to place their devices in most cases. Shockwave could potentially make it easier to place some of their devices after “crack and pave” to reopen the vasculature by preventing recoil in heavily calcified lesions. I do a lot of peripheral work and I’m just not seeing its use other than in niche areas where you want more gentle inflations to avoid stenting (like the popliteal or CFA). Personally, I’d rather just go subintimal and reenter distally, place a Viabahn covered stent then go to 30 ATM with the balloon inside the Viabahn and rupture the calcified plaque to prevent recoil (we give tumescent around the artery beforehand to prevent pain). I’m usually pretty quick to adopt new tech but I’ll be waiting on this one to see if it truly has any benefit over my current strategy.
The investment puzzles me still as I’ve said on many occasions. Maybe I’ll be wrong.
Our vascular surgeons requested this about a year ago.
It got delayed a long time in the approval and there wasn’t much squawking about it.
When asked they still want it but think use of it will be very low. Niche-type use, case here, case there.
FWIW.
Gator