Pascal Girin, CEO of BALT, shares how his rich career in neurovascular medical technology helped him to transform the company from a small R&D pure player into an international market leader. Girin goes on to explain the high key growth strategy he is implementing and the impact that BALT’s products can have on the quickly developing medical field of stroke treatment.


Mr Girin, you have had a long-standing career in the medtech sector, holding several senior positions in major companies. How did you come to join BALT?

I have spent most of my career working with American companies, with a long history of acting as a European regional head. In 2007, I moved to the US to work for a company called Ev3, which is directly connected to what I am doing at BALT today.

Ev3 was established by bringing up several small innovative start-ups in the neurovascular field. I started off by heading the European operations, starting the company’s business from scratch, and expanding to Japan and China. After, I moved to southern California to take on the role of COO for what is now a market leader in the peripheral vascular and neurovascular fields. In 2010, Ev3 was acquired by Covidien which was later acquired by Medtronic and became the leader in neurovascular thanks to this.

Later on, I joined Wright Medical as COO and helped to transform the company, selling off the hip and knee business to focus on extremity solutions. This change helped to establish Wright Medical today as one of the leading players in the extremities therapeutic area. At this point, I was contacted with an opportunity to help lead a small pure-play neuroradiology company based in France – BALT.


Can you please present BALT, today a leading player in interventional neuroradiology?

Since being founded in 1977, BALT has been run as a very successful small family-owned company, with a very heavy focus on R&D. BALT had an outstanding product portfolio and was instrumental in leading the emersion of Interventional Neuroradiology, a medical specialty that began to pick up speed 40 years ago. However, today the entire industry has completely transformed and the regulatory environment has changed. BALT did not have the core competencies to adapt with competition coming from Asia and the US, and the increasing amount of data and clinical information required by regulators.

Therefore, the son of the founder decided to partner with the private equity firm, Bridgepoint, and a strategy was identified to focus on commercial growth and international expansion – particularly in the US. Here, I joined as CEO of BALT international to lead the company’s expansion and altogether became the first nonfamily member CEO of BALT in 2018.


What has been your strategy for BALT since joining the company?

The first pillar of BALT’s new strategy was to build a global team as the company’s entire operational office was being managed out of France. We began by recruiting international managers to handle different regions of BALT’s business, which I was able to build through the extensive network I had developed throughout my career.

The next step was to establish ourselves directly in our key markets rather than working primarily through a network of distributors. It is very challenging to manage a business and truly drive growth by relying only on third-party partners. We took this step by either buying out distributors who we had relations with or simply setting up an office. Today, BALT is present in Spain, Germany, the Nordics, India, and China. In Japan, we have chosen to continue working with a distributor with whom we have a very strong partnership and in Brazil, we are expecting to complete a deal which will allow us to enter the market by the end of this year.

In the US, we acquired a small company, Blockade Medical, which gave us two important assets – a product line of coils for the treatment of aneurysms that was missing in BALT’s portfolio and a US footprint. This means BALT has now a product portfolio as wide as leading players like Medtronic or Stryker. Additionally, the company had a fantastic management team who were very senior and experienced. This company had a small manufacturing facility, but we moved operations to a much larger one which will have an objective to continue manufacturing coils and new products coming to our R&D activities. This year, we expect our sales from the US to increase to 15 percent of our global total.


From 2015 to 2018, BALT more than doubled its turnover and reached EUR 100 million in global sales. How did the company adjust to such an abrupt growth spurt?

I consider myself to be a growth leader and the most difficult aspect of growth is in adapting systems and processes. The key is building one company and ensuring the rest of the organization is following in the right direction. To create an international company, I established global R&D sites in France and the US and of course, having a strong management team to keep BALT moving in unison was fundamental.


How challenging is it to bring together an international workforce with different working styles and culture?

I tell my team that I am bringing together the best aspects of each country. For example, the French are very good at innovation but struggle in creating efficient processes. The Americans are also good at innovation, but their ability to build efficient operational structures is second to none. I have no doubt that if I can bring the skills of all my leaders together BALT will have no issue in succeeding.


The creation of BALT’s microcatheters and implants is an extremely delicate process that requires a high level of precision and manual skill. What are the challenges BALT faces in the manufacturing of such delicate products in order to meet market demands?

The number one problem of BALT today is meeting market demands. Our products have very unique features and I truly believe they are the best on the market in terms of quality and technology. Given our long-standing history of innovation and collaboration with physicians, we have created a strong portfolio. In the US, we built our new factory from scratch, with large production potential. However, our factory here in Val-d’Oise, France is excellent in producing small series batches, but we need to transform this site into a large-scale operation. Therefore, this January we initiated an investment program to double our capacity in France through the modernization of equipment and application of lean principles to the production process. BALT has a high-class team of operators that are exceptional at what they do, so now we need to scale this operation even further.


How important is innovation to BALT and what unmet medical needs are the company’s products aiming to fulfill?

To be a successful CEO in this industry, I truly believe a leader must be innovation-driven and have a love and understanding of the technology. There needs to be active dialogue with physicians to discuss clinical data, new indications, and what the future of this medical discipline can be. The global neurovascular market is valued at USD 2.5 billion and grows 15 to 20 percent every year. If every patient in developed health markets in this field were treated, the market would have the potential to be USD 12 billion in size. Stroke is the second largest cause of death in the world and many patients are not well treated in this area.

Although much progress has been made, there is a huge unmet medical need in stroke still. Ischemic stroke accounts for 85 percent of stroke patients and up until recently, there were no effective treatments outside of a six-hour window. The latest clinical studies show that with today’s treatment options that neurovascular companies like BALT have, patients can be treated up to 16 or 24 hours after onset.

Furthermore, the improvement of treatment in stroke can be attributed to the developments in hospital and healthcare infrastructures. The US is leading this trend and has organized itself very well in terms of stroke centre networks. Europe has also done well in this area but many other countries in the world are still behind. Even if the right tools are in the hands of the right clinicians, if patients cannot reach the necessary medical centres, they will not be able to have the best treatment.


What has been your experience working with US regulators to bring BALT’s unique products to market?

The entry point of the US is high because the FDA is strict in its requirement of level of data to obtain market approval, especially for Class 3 devices –implants compared to Class 2 which are access products. Class 2 products which are the catheters that allow physicians to reach the precise treatment location can gain approval from information gathered from long-standing real usage, whereas Class 3 devices which stay in the body like stents need extensive clinical data gathered from trials. A typical trial in this field of medicine may last between 2 to 3 years using patient groups of hundreds rather than thousands. This is a large investment for small players like BALT, but it is an advantage as it opens the door to the US market where the usage per capita is high.


What would be the advice you can offer to a general manager coming to France for the first time?

Accepting cultural differences is the first in success. Typically, the French have many intelligent ideas to offer, but you just have to be patient and try to understand their viewpoint and meaning. A leader in France should focus the people here on their core strengths while complementing and supporting their weaknesses. I have always found that French companies often have either a lack of or overly complex operational processes without a good balance. Lastly, mixing the French culture and backing it with others from around the world is very effective. And of course, speaking French!