Among the embolization devices, embolic coils will continue to be widely adopted for intracranial aneurysm treatment given the extensive clinical experience with such devices, and their use in both ruptured and unruptured aneurysms. Innovative coils have been developed to provide increased packing density, conformability, and stability. Liquid embolic agents such as Onyx have been, and will continue to be adopted to embolize intracranial arteriovenous malformations (AVMs). The adoption of emerging technologies such as flow diverters will increase only slowly in the future and is expected to take market share away from the stent-assisted and balloon-assisted coiling markets. However, the use of flow diverters is limited to niche aneurysm indications such as wide-neck, large, and giant aneurysms. In addition, the high cost of flow diverters compared with coils and remodeling devices, as well as a lack of reimbursement in countries such as Brazil, will hinder the widespread adoption of flow diverters. 

 

Outcomes of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) clinical trial demonstrating a lack of superior clinical performance of endovascular therapy versus medical therapy has limited the use of stents for treating intracranial stenosis. Stenting and balloon angioplasty are primarily performed in the setting of carotid artery stenosis. Low-profile stent systems have been designed to improve flexibility, radial strength, and conformability. Although innovative stent/balloon technologies with integrated embolic protection have been developed, GlobalData questions the widespread adoption of such revascularization devices in the future, given the lack of clinical data and appropriate reimbursement in countries such as the US and Brazil. However, in China, the procedure volume for stenting is much higher than in the US and EU and can be attributed to physician clinical experience and expertise, as well as a high prevalence of disease.