Device companies large and small have failed repeatedly in efforts to address bifurcations, which remain one of the largest unmet opportunities in cardiology. Cappella thinks it can solve the problem with a device that's a new version of an old idea, reversing current protocol to treat the side branch first.

Many believe that the one-size-fits-all approach to drug-eluting stent design taken not only by the current market players, Cordis and Boston Scientific, but also by several companies with products nearing approval--e.g., Medtronic, Guidant and Abbott Laboratories-is a contributor to the problem of complications. Today's uniform manufacturing processes ensure that every stent is identical in polymer coating and drug dosage, and that means that the amount of polymer and drug generally may exceed the amount needed to prevent restenosis. Labcoat is focusing on a process by which it can coat stents with varying amounts of drug and polymer to address specific patient needs. Using precision jetting (similar to inkjet printer technology), the company can apply droplets of bioerodable polymer and drug on a stent in a precise pattern. Instead of coating the entire device, Labcoat can more precisely dose both drug and polymer so that the patient's vessels are only exposed to the minimal required amount of each substance, while the inside surface of the stent remains bare, to encourage more rapid and complete endothelial coverage. By using less drug and polymer, Labcoat hopes to minimize the thrombosis complications, and also provide a less expensive product that can be adapted to treat a broad range of patients.

The early-to-mid 1990s marked the rise of a huge wave of interest in women's health among device start-ups and investors. Several women's health companies, including Conceptus, were among the ill-fated IPO Class of 1996 that largely failed to meet investor expectations. Most of these start-ups are no longer around, but Conceptus re-trenched and shifted its emphasis from fertility to a new approach to sterilization, which finally received FDA clearance late last year. The company has survived the pitfalls that derailed other women's health start-ups, most notably a customer group that is difficult to access and slow to adopt new technology, and a challenging reimbursement environment, but in doing so, may be the exception that proves the rule.

The Massachusetts-based Seedling Enterprises Inc. works with inventors who have ideas but don't know how to make them commercially viable. It selects the most promising ones, develops them, and, rather than forming a company, shops them around to potential device acquirers. Venture capitalists typically aren't interested because their targeted markets are too small. While the products may be niche, the returns, theoretically, can be pretty good--almost as good as VC returns, says co-founder Josh Tolkoff.