For the most part, medical device maker Boston Scientific (NYSE:BSX) is still reeling from drug-eluting stent challenges and difficulties encountered after boldly acquiring rival Guidant last April. A full recovery may be some time off, but a couple of positive signs are beginning to surface.

First-quarter results released after the market closed yesterday continue to be plagued by merger integration charges, as well as general concerns over side effects and how effective drug-eluting stents are as compared to using other means (such as drugs) to open arteries, relieve chest pain, and improve blood flow in patients. The drug-eluting stents release medicine from a coating to keep the artery open.

The Guidant acquisition was originally intended to diversify Boston's Taxus drug-eluting stent focus. It did add welcome exposure to cardiac rhythm management (CRM) with products that help the heart beat properly. Unfortunately, it also added the nasty side effect of product quality issues in implantable cardiac defibrillators, which have hit sales trends at the CRM segment.

In other words, Boston Scientific's woes are coming from all angles, but the company's overall pulse may be getting stronger. Sales fell across the board when including Guidant-related sales in last year's first quarter, but did improve in a couple of categories on a sequential basis. And, if you look at the glass as half full, double-digit falls in drug-eluting stent sales mean that Guidant-related CRM sales now account for the bulk of sales, making the acquisition potentially worthwhile.

And after some unscientific results to end last year, the recently filed 10-K highlighted that cash flow generation was decent. Based on the cash flow statement, free cash flow looks to have come in at about $1 per share, implying the stock is trading at less than 16 times free cash. That could turn out to be a very favorable multiple if sales trends reverse course and current profitability can be maintained. On the flipside, if sales continue to fall, then the heavy debt load taken on to acquire Guidant could become even more cumbersome. Note that interest expense was half of operating income for the quarter.

At current prices, the risk/reward tradeoff appears favorable enough to warrant a full checkup on the stock. And if drug-eluting stent sales recover, Boston Scientific could be able to outperform competitors including Johnson & Johnson (NYSE:JNJ) and Abbott Labs (NYSE:ABT). Plus, Medtronic (NYSE:MDT) is just getting warmed up in the space, demonstrating it still has long-term appeal, as does the CRM business.

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Fool contributor Ryan Fuhrmann is long shares of JNJ but has no financial interest in any other company mentioned. Feel free to email him with feedback or to discuss any company mentioned. The Fool has an ironclad disclosure policy.