For those of you who have entered the world of athrectomy/atherectomy you might be following the trajectory of CSI(Cardiovascular Systems Inc) which was ramping up to conduct an IPO. Information surfaced in early November 2008 that due to the challenging economic conditions and the IPO drought, they would merge with a struggling existing publicly traded company Replidyne. By reports, Replidyne is essentially a shell company with no products, no revenue and very few employees. What they do have is a Nasdaq listing and a ticker symbol.
Over the past few months, IPOs have ground to a halt, forcing companies to either postpone or pull their stock debuts altogether. In the first nine months of this year, 77 companies withdrew their IPOs, 19 in the third quarter alone, according to Bloomberg News. Through September, just 55 companies have gone public, down from 226 during the same period in 2007.
Getting creative
Im interested to get some feedback on this device. We know that the Silverhawk formerly of Foxhollow and now EV3 fame had limitations such as an inability to treat vessel calcification. The initial company push for the Diamondback is for the treatment of calcific athero-occlusive disease. I have successfully used it in densely calcified infra popliteal vessels. The question becomes, depending upon ones population, is the presence of segmentally, calcified infra pop disease so infrequent as to make the indicated use for this device relatively few and far between. I have used it on minimally calcified vessels with underwhelming results as one would expect based upon its theoretical mechanism of action which is atherectomy of calcific, non compliant tissue.
The major cost associated with the device include multiple catheter sizes and a couple of different crown types for various disease levels. To date, my impression is that a lot of enthusiasm for this device is in the interventional cardiology space. I feel that durable results with minimally invasive technology is really limited to focal tibial level disease with good run off. Unfortunately, many of the diabetic and renal insufficiency patients with dense calcific vessel disease have an extremely diffuse pattern. And in the circumstance when there is significant tissue loss, I personally feel that direct pulsatile flow to the area of tissue loss is the most reliable means of salvaging the limb if adequate conduit is available. Furthermore, products like the propaten graft from Gore Medical and the Venaflo from CR Bard offer reasonable alternatives to spliced vein autologous vessel bypass.
Bottom line, is that I would like to get a some feedback on what others are experiencing in their practice with the use of this technology.
