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Goodwill and Intangible Assets | 9 Months Ended
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Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets | 6. Goodwill and Intangible Assets. The change in the carrying amount of goodwill for the nine-month period ended September 30, 2021 is detailed as follows (in thousands): ​
​ | ​ | ​ | ​
​ |  | 2021
Goodwill balance at January 1 | ​ | $ | 363,533
Effect of foreign exchange | ​ |  | (1,533)
Goodwill balance at September 30 | ​ | $ | 362,000
​ Total accumulated goodwill impairment losses aggregated to approximately $8.3 million as of September 30, 2021 and December 31, 2020. We did not have any goodwill impairments for the nine-month periods ended September 30, 2021 and 2020. The total goodwill balance as of September 30, 2021 and December 31, 2020 was related to our cardiovascular segment. ​ Other intangible assets at September 30, 2021 and December 31, 2020 consisted of the following (in thousands): ​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | September 30, 2021
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 25,635 | ​ | $ | (7,826) | ​ | $ | 17,809
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,469) | ​ |  | 781
License agreements | ​ |  | 12,678 | ​ |  | (7,478) | ​ |  | 5,200
Trademarks | ​ |  | 30,252 | ​ |  | (14,566) | ​ |  | 15,686
Customer lists | ​ |  | 35,035 | ​ |  | (30,691) | ​ |  | 4,344
Total | ​ | $ | 106,850 | ​ | $ | (63,030) | ​ | $ | 43,820
​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2020
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 23,669 | ​ | $ | (6,460) | ​ | $ | 17,209
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,319) | ​ |  | 931
License agreements | ​ |  | 14,453 | ​ |  | (6,647) | ​ |  | 7,806
Trademarks | ​ |  | 30,273 | ​ |  | (12,414) | ​ |  | 17,859
Customer lists | ​ |  | 35,154 | ​ |  | (29,103) | ​ |  | 6,051
Total | ​ | $ | 106,799 | ​ | $ | (56,943) | ​ | $ | 49,856
​ Aggregate amortization expense for the three and nine-month periods ended September 30, 2021 was approximately $12.4 million and $37.3 million, respectively. Aggregate amortization expense for the three and nine-month periods ended September 30, 2020 was approximately $14.4 million and $44.2 million, respectively. ​ We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows is largely independent of the cash flows of other assets and liabilities. We determine the fair value of our amortizing assets based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities. During the nine-month periods ended September 30, 2021 and 2020, we identified indicators of impairment associated with certain acquired intangible assets within the asset groups based on our qualitative assessment. The primary indicator of impairment was our planned discontinuance of the Advocate™ Peripheral Angioplasty Balloon product line, sold under our license agreements with ArraVasc Limited (“ArraVasc”). We recorded an impairment charge for the remaining carrying value of ArraVasc intangible assets of approximately $1.6 million during the nine months ended September 30, 2021, all of which pertained to our cardiovascular segment. ​ We recorded total impairment charges associated with intangible assets in our cardiovascular segment for the three and nine-month periods ended September 30, 2020 of approximately $18.1 million and $20.5 million, respectively. These expenses are reflected within impairment charges in our consolidated statements of income (loss). The primary factors driving impairment of certain intangible assets for the three and nine-month periods ended September 30, 2020 were planned closure and restructuring activities and uncertainty about future product development and commercialization associated with the acquired technologies due in part to the economic impacts of the COVID-19 pandemic. The intangible impairment charges related to a write-off or reduction in value of intangible assets from our August 2017 acquisition of certain assets from Laurane Medical S.A.S, our license agreements with ArraVasc Limited, intangible assets from our May 2018 acquisition of certain assets from DirectACCESS Medical, LLC, in-process technology intangible assets of Sontina Medical LLC we acquired through our February 2018 acquisition of certain divested assets from Becton, Dickinson and Company, and a customer list intangible asset from our October 2017 acquisition of ITL Healthcare Pty Ltd (“ITL”). ​ See Note 14 for additional details regarding impairment charges recorded in the three and nine-month periods ended September 30, 2021 and 2020. ​ Estimated amortization expense for the developed technology and other intangible assets for the next five years consisted of the following as of September 30, 2021 (in thousands): ​
​ | ​ | ​ | ​
Year Ending December 31, |  | Estimated Amortization Expense
Remaining 2021 | ​ | $ | 12,279
2022 | ​ |  | 48,158
2023 | ​ |  | 47,060
2024 | ​ | ​ | 44,126
2025 | ​ |  | 42,354
​

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