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Catalysts of Change: Four Innovations Redefining Interventional Cardiology

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Interventional cardiology continues to advance toward precision-based care, where treatment strategies are matched to patient characteristics and real-world outcomes guide decision-making. Coming out of TCT 2025, one of the leading interventional cardiology conferences, Trinity sees four trends shaping the next 2-3 years in the interventional cardiology market.  

 

1. Alternatives to Drug-Eluting Stents Are Back in Focus 

For years, drug-eluting stents (DES) have been the default in percutaneous coronary intervention (PCI), but that dominance is being challenged. The SELUTION DeNovo trial (n≈3,300) showed that a “leave nothing behind” approach using sirolimus-eluting drug-coated balloons (DCBs) and provisional stenting was non-inferior to routine DES at one year with nearly 80% of patients avoiding a stent, an important validation of metalsparing PCI strategies. Similarly, SELUTION4ISR reinforced the credibility of DCBs such as Cordis’ SELUTION for instent restenosis. Resorbable scaffolds also re-emerged, with next-generation designs aiming to overcome earlier limitations – it’s clear that alternatives to DES are increasingly gaining clinical acceptance. 

 

2. Device Options for Calcium Modification are Expanding   

Severe calcification remains one of the toughest challenges in PCI. While Shockwave (J&J) continues to dominate with its intravascular lithotripsy (IVL) platform, randomized trials like ShortCUT and VICTORY suggest that cutting balloons and ultra-high-pressure balloons, like the SIS Medical OPN, can achieve comparable stent expansion in certain lesions, and potentially with cost and workflow advantages.  

The result is a more tailored approach to calcium modification, where device choice reflects lesion characteristics and operator preference. Continued evolution in crossing systems and next generation IVL platforms are expected to expand therapy options and improve workflow efficiency. 

 

3. Monopolistic Device Markets Are Facing Real Competition

Two markets, both built and historically “owned” by their founding products – Left Atrial Appendage Closure (LAAC) and Temporary Mechanical Circulatory Support (tMCS) – are entering a more competitive phase. 

  • In LAAC, Boston Scientific’s WATCHMAN still anchors a >$2 billion category, but challengers are emerging with differentiated designs and trials exploring new antithrombotic strategies. ANDES antithrombotic strategies, long-term Amulet outcomes, and ongoing head-to-heads signal a more competitive and evidence rich phase. 
  • In tMCS, Abiomed’s Impella remains the incumbent, but small-bore devices promising lower hemolysis and easier deployment are gaining attention. Whether these challengers can build the same depth of evidence to drive adoption and differentiate beyond engineering features remains unclear; however, it’s likely that Abiomed will soon have competition.  

 

4. Renal Denervation Shows Cautious Optimism 

Long-term data for renal denervation (RDN) continue to validate blood pressure reductions without medication escalation, positioning RDN as a potential adjunct therapy for select hypertensive patients. Several physicians and industry experts have compared the uptake of RDN to the early days of Watchman, with talks of becoming a “blockbuster” device. With the recently announced positive Medicare National Coverage Determination, enthusiasm continues to rise for Medtronic’s Simplicity and Recor Medical’s Paradise as these systems move closer to broad clinical adoption.  

 

Precision and progress

As 2025 draws to a close, the trends presented at TCT and echoed throughout the interventional cardiology community reinforce a core principle: the future hinges on agility and evidence-driven care. Trinity MedTech works closely with leading and emerging MedTech organizations to translate insights and clinical realities into strategies that capture new opportunities, spark category leadership, and drive commercial momentum. In the years ahead, those who champion both innovation and practical adoption—matching the right device to the right patient, every time—will set the pace in interventional cardiology.

Authors: Robert Cohen, Paul O’Mahoney, MD 

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