Medtronic Focuses on Carotid Therapies, Thrombectomy, and BTK Disease; Exits AVF Creation

June 13, 2025—With a distribution agreement in place and an option to acquire Contego Medical, Medtronic’s peripheral vascular division kicked off 2025 with renewed investment in the carotid artery stenting (CAS) field. The move signaled the start of what could be a transformative period in several of the division’s business units, with new product lines and updates to legacy platforms across carotid and venous disease, dialysis access, and peripheral artery disease (PAD), including one notable exit. To find out more about the company’s plans for the near future and how it is responding to opportunities and headwinds in the markets it serves, Endovascular Today interviewed Dave Moeller, Medtronic’s SVP and President, Peripheral Vascular Health.

CAROTID REVASCULARIZATION

As mentioned, Medtronic recently reestablished its foothold in the carotid revascularization market with its interest in Contego Medical, a relationship that began with a strategic investment several years ago. Moeller noted that while the company already has a carotid stent and a pair of embolic protection systems (both distal and proximal) in its legacy portfolio, the combination of the 2023 Medicare reimbursement expansion for CAS and the clinical trial success seen with Contego’s Neuroguard system has brought carotid back to the forefront for Medtronic. The company took over distribution of Contego’s recently FDA-approved transfemoral system in May. The PERFORMANCE III clinical trial for the Neuroguard IEP Direct, a carotid stent system designed for direct transcarotid access, is currently underway under Contego’s oversight, with enrollment expected to be completed sometime this year.

Moeller said the company will take a thoughtful approach to rolling out its carotid offering, starting with high-volume centers and followed by medium- and lower-volume centers, acknowledging the need for initial proctoring and ongoing support. “Medtronic is well-suited for this space because we have a large sales channel for peripheral vascular and neurovascular. So, both sales forces will carry the transfemoral platform.”

PAD THERAPIES

Asked about challenges facing the PAD revascularization market in recent years, Moeller first spoke on the company’s response to calls for clinical data to address perceived concerns over the relative lack of atherectomy studies, as well as its potential overuse. Medtronic worked with leading vascular physicians to develop a systematic literature review (SLR), which Moeller noted found more than 300 published papers on atherectomy, including 11 meta-analyses and 18 randomized controlled trials, as well as many observational studies. Presented most recently at the 2025 Charing Cross Symposium by Prof. Thomas Zeller, the SLR supported the safety and effectiveness of atherectomy across a variety of patient and lesion subgroups, including above and below the knee, calcification, claudication, and chronic limb-threatening ischemia.

On the drug-coated balloon (DCB) front, Moeller noted that Medtronic continues to extend its peripheral DCB program, with an anticipated expansion of its size matrix to include longer balloon lengths of the 0.018-inch wire, as well as a below-the-knee application.

Although it is too early to provide specifics, Moeller pointed to below-the-knee disease as the most significant unsolved need for the sickest patients, indicating that work is underway for new treatment options. “In DCBs—where we have been the global market leader for a very long time—we intend on extending that lead below the knee,” he said. “We are revising the technology and preparing for a clinical trial.”

VENOUS DISEASE AND PERIPHERAL THROMBECTOMY

On the horizon in the venous market is the planned launch of a new mechanical thrombectomy system called Liberant. The platform will leverage technology developed in the company’s neurovascular division and advancements it has made in blood conservation and catheter technology. Medtronic can also leverage the knowledge gained via their current presence in the deep venous stent space with the Abre device, Moeller said. Additionally, Contego has developed Excipio, which works in conjunction with Medtronic’s mechanical aspiration system.

On the superficial venous side, Moeller discussed the company’s investment in the VenaSeal Spectrum program. Spectrum comprised two randomized trials and a single-arm study, the latter of which was presented at Charing Cross 2025 and focused on wound healing after the VenaSeal procedure in CEAP 6 patients. When asked about headwinds in the superficial venous market, Moeller responded, “The future of reimbursement.” Ensuring payment rates remain stable and gaining reimbursement coverage from the few remaining payors who do not currently cover VenaSeal are the company’s biggest reimbursement priorities for the therapy.

DIALYSIS ACCESS

In the dialysis access field, Medtronic will maintain its presence with the In.Pact AV DCB, which Moeller says is a growth driver in many parts of the world. However, the company is exiting the fistula creation market after 4 years of investment in its development, supporting the Ellipsys platform. Moeller spoke on the challenges of “changing a 50-year-old standard of care,” such as finding the right patients, mapping them, and successfully maturing and cannulating the fistula. “Creating the fistula was the easy part,” said Moeller. “The technology works great, and the actual creation was fine. Postcreation, it’s a lower-flow fistula than a surgical fistula, so it’s not as visible [and] a little more difficult to cannulate.” There were also challenges in training on proper cannulation and referral hurdles, with nephrologists opting to refer patients for surgical fistulas if they had encountered any problems with percutaneous fistulas.

“There were some really passionate physicians who were able to develop that whole ecosystem necessary to get it rolling, but very few,” he said. Without getting to a critical mass point, “the demand was not sufficient to support further investment.” With the surgical option still available, a different percutaneous option on the market, and others possibly making their way, Moeller said the company felt it would be leaving patients with suitable alternatives. “I’m proud of the fact that we took a swing. We took a chance on something that could be exciting. We’ll continue to take gambles like that.”

FUTURE FOCUS

Optimistic about the opportunities in the year ahead and realistic about the market’s challenges, Moeller anticipates more launches from Medtronic over the next year or two than in the previous five.

“We’re entering a period of innovation,” Moeller said. “We are going after spaces where we can lead and where we can leverage our existing strengths to solve the most important unmet needs in peripheral vascular care.”