A decade ago, incuabators were seen as the best medicine for what then ailed the medical device industry, most notably a complex regulatory pathway and a difficult venture financing climate. Perhaps not surprisingly, as both the regulatory path and venture financing grew easier in the mid 2000s, incubators began to struggle, victims of their own financing problems. More recently, two huge acquisitions, Abbott's purchase of Evalve and Medtronic's of Ardian, suggest that at least one incubator, The Foundry, is proving that incubation works.

Which kinds of innovations make for incremental enhancements in the hands of large companies and which are meaningful enough to sustain a venture-backed start-up company? In a mature market for coronary stents dominated by large companies, start-ups developing new stents need to find the answers. Areas of innovation fall into four basic categories: improving stent safety and biocompatibility, avoiding the need for dual antiplatelet therapy, enhancing deliverability, and introducing specialty stents for complex vessels. Three companies profiled here have a plan for taking sufficient market share, reducing risk, and rewarding investors.

Growth by innovation is almost considered a birthright in interventional cardiology, and based on presentations at this year's Transcatheter Cardiovascular Therapeutics meeting, held this September in San Francisco, it seems clear that innovation still reigns supreme in this specialty. However, as in other medical device markets, ongoing economic and regulatory pressures are taking their toll, particularly in the drug-eluting stent market, as the field adjusts to a new era of cost control and economic uncertainty.