Penumbra Inc (PEN) 2023 Q2 法說會逐字稿

Good afternoon. My name is Brent, and I will be your conference operator today. At this time, I would like to welcome everyone to Penumbra's Second Quarter 2023 Conference Call. (Operator Instructions) I would like to introduce Ms. Jee Hamlyn-Harris, Investor Relations for Penumbra. Ms. Hamlyn-Harris, you may begin your conference.

下午好。我叫布倫特，今天我將擔任你們的會議操作員。此時，我謹歡迎大家參加 Penumbra 2023 年第二季度電話會議。 （操作員說明）我想介紹一下 Penumbra 投資者關係部門的 Jee Hamlyn-Harris 女士。 Hamlyn-Harris 女士，您可以開始會議了。

Thank you, operator, and thank you all for joining us on today's call to discuss Penumbra's Earnings Release for the Second Quarter of 2023. A copy of the press release and financial tables, which includes a GAAP to non-GAAP reconciliation can be viewed under the Investors tab on our company website at www.penumbrainc.com.

感謝運營商，感謝大家參加今天的電話會議，討論 Penumbra 2023 年第二季度的收益發布。新聞稿和財務表格的副本，其中包括 GAAP 與非 GAAP 調節表，請參見我們公司網站www.penumbrainc.com上的“投資者”選項卡。

During the course of this conference call, the company will make forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements regarding our financial performance, commercialization, clinical trials, regulatory status, quality, compliance and business trends.

在本次電話會議期間，公司將根據1995 年《私人證券訴訟改革法案》的安全港條款做出前瞻性聲明，包括有關我們的財務業績、商業化、臨床試驗、監管狀況、質量、合規性的聲明和商業趨勢。

Actual results could differ materially from those stated or implied by our forward-looking statements due to certain risks and uncertainties, including those referenced in our 10-K for the year ended December 31, 2022, filed with the SEC.

由於某些風險和不確定性，包括我們向SEC 提交的截至2022 年12 月31 日的10-K 年度報告中提到的風險和不確定性，實際結果可能與我們的前瞻性陳述中明示或暗示的結果存在重大差異。

As a result, we caution you against placing undue reliance on these forward-looking statements, and we encourage you to review our periodic filings with the SEC, including the 10-K previously mentioned, for a more complete discussion of these factors and other risks that may affect our future results or the market price of our stock. Penumbra disclaims any duty to update or revise our forward-looking statements as a result of new information, future events, developments or otherwise.

因此，我們提醒您不要過分依賴這些前瞻性陳述，並鼓勵您查看我們向 SEC 提交的定期文件，包括前面提到的 10-K，以便更完整地討論這些因素和其他風險這可能會影響我們未來的業績或我們股票的市場價格。 Penumbra 不承擔因新信息、未來事件、事態發展或其他原因而更新或修改我們的前瞻性陳述的義務。

On this call, certain financial measures are presented on a non-GAAP basis. The corresponding GAAP measures and a reconciliation of GAAP to non-GAAP financial measures are provided in our posted press release.

在本次電話會議上，某些財務指標是根據非公認會計原則提出的。我們發布的新聞稿中提供了相應的 GAAP 衡量標準以及 GAAP 與非 GAAP 財務衡量標準的調節表。

Adam Elsesser, Penumbra's Chairman and CEO, will provide a business update. Maggie Yuen, our Chief Financial Officer, will then discuss our financial results for the quarter. And Jason Mills, our Executive Vice President of Strategy, will discuss our 2023 guidance.

Penumbra 董事長兼首席執行官 Adam Elsesser 將提供業務最新動態。我們的首席財務官 Maggie Yuen 隨後將討論我們本季度的財務業績。我們的戰略執行副總裁 Jason Mills 將討論我們的 2023 年指導方針。

With that, I would like to turn over the call to Adam Elsesser.

至此，我想將電話轉給 Adam Elsesser。

Thank you, Jee. Good afternoon. Thank you for joining Penumbra's Second Quarter 2023 Conference Call. Our total revenues for the second quarter were $261.5 million, a year-over-year increase of 25.5% as reported and on a constant currency basis. Our revenue growth in the United States accelerated to 32% year-over-year our fastest in half a decade, excluding the COVID impacted second quarter of 2020. U.S. growth was driven by our thrombectomy products in both vascular and neuro as total U.S. thrombectomy revenue increased more than 40% year-over-year. U.S. vascular thrombectomy revenue accelerated to 50% year-over-year growth and U.S. neurothrombectomy grew 20% year-over-year, the fastest growth in our U.S. stroke business in 5 years.

謝謝你，傑。下午好。感謝您參加 Penumbra 2023 年第二季度電話會議。我們第二季度的總收入為 2.615 億美元，按固定匯率計算，同比增長 25.5%。我們在美國的收入同比增長加速至32%，這是五年來最快的，不包括2020 年第二季度新冠疫情的影響。美國的增長是由我們在血管和神經領域的血栓切除產品推動的，因為美國血栓切除總收入同比增長超過40%。美國血管血栓切除術收入同比增長 50%，美國神經血栓切除術收入同比增長 20%，這是我們美國中風業務 5 年來最快的增長。

We expanded gross margins in the second quarter, consistent with our expectations and we expect to make more progress in the second half of the year. We also increased our operating profitability in the second quarter. Non-GAAP operating income was $20.3 million, representing 7.8% of revenue in the second quarter. We grew our operating cash balance by $22 million sequentially as well. Looking forward, we expect to deliver strong revenue growth, gross margin expansion and increasing profitability and cash flow over the foreseeable future.

我們在第二季度擴大了毛利率，與我們的預期一致，我們預計下半年將取得更多進展。第二季度我們的運營利潤率也有所提高。非 GAAP 營業收入為 2030 萬美元，佔第二季度收入的 7.8%。我們的運營現金餘額也連續增加了 2200 萬美元。展望未來，我們預計在可預見的未來將實現強勁的收入增長、毛利率擴張以及盈利能力和現金流的增加。

Penumbra had a very successful quarter, and we are still in the early stages of the journey to bring our proprietary thrombectomy technologies to patients in the United States and around the world. Our momentum is being driven by the extraordinary outcomes we are seeing in patients treated with Lightning Flash, Lightning Bolt 7 and RED 72 with SENDit technology in the early days of launch for each of these products.

Penumbra 有一個非常成功的季度，我們仍處於將我們專有的血栓切除技術帶給美國和世界各地患者的早期階段。我們的動力來自於在每種產品推出之初，我們在採用 SENDit 技術的 Lightning Flash、Lightning Bolt 7 和 RED 72 治療患者中看到的非凡療效。

Starting with Lightning Flash, we doubled the number of venous thrombectomy cases employing Flash in the second quarter compared to the first quarter. And we grew our total venous case volume double digits sequentially, coming off a very strong Q1. We had another extraordinary quarter with Lightning Flash, and we have many more new customers just learning about and starting to try Flash in the next several quarters.

從 Lightning Flash 開始，我們第二季度使用 Flash 的靜脈血栓切除術病例數比第一季度增加了一倍。我們的總靜脈病例量連續兩位數增長，第一季度表現非常強勁。我們在 Lightning Flash 方面又度過了一個非凡的季度，並且在接下來的幾個季度中，我們有更多的新客戶剛剛了解並開始嘗試 Flash。

Lightning Flash's transformative power, speed, safety, and efficacy profile is the biggest driver of the exceptional early adoption of the product.

Lightning Flash 的變革性力量、速度、安全性和功效是該產品獲得早期採用的最大推動力。

The other important factor resonating with physicians is our straightforward pricing, which adheres to the same simple value-sharing pricing philosophy to which we've been committed throughout our history.

引起醫生共鳴的另一個重要因素是我們直接的定價，它遵循我們在整個歷史中一直致力於的相同簡單的價值共享定價理念。

Moving to Lightning Bolt 7. Our U.S. arterial revenue grew double-digits sequentially, representing the fastest growth in this franchise since the launch of Lightning 7 in early 2021. We saw acceleration of Lightning Bolt 7 cases in the last 2 months of the quarter as conversion from surgery, lytics and other mechanical thrombectomy products gained momentum. That said, we are even earlier in the launch process for Lightning Bolt 7 than we were with Flash this time last quarter as many prospective customers are waited to allow some time to pass before starting the back process for Bolt after engaging in the same process for Lightning Flash last quarter.

轉向Lightning Bolt 7。我們的美國干線收入連續增長兩位數，這是自2021 年初推出Lightning 7 以來該系列產品中最快的增長。我們看到Lightning Bolt 7 病例在本季度最後2 個月加速增長：手術、溶栓和其他機械取栓產品的轉換勢頭強勁。也就是說，我們在Lightning Bolt 7 的啟動過程中甚至比上個季度此時的Flash 還要早，因為許多潛在客戶在參與了與Flash 相同的流程後，都在等待一段時間，然後再開始Bolt的後台流程。上個季度的閃電。

Consequently, we think that adoption of Lightning Bolt 7 will build momentum as we move through this quarter and into the fourth quarter of 2023 and the first quarter of 2024. Taken together, Lightning Flash and Lightning Bolt 7 have generated more pending hospital customers than during any other launch in our history. We currently have well over 1,000 active submissions in hospitals for approval of either Lightning Flash or Lightning Bolt 7.

因此，我們認為，隨著本季度、2023 年第四季度和2024 年第一季度的到來，Lightning Bolt 7 的採用將形成勢頭。總的來說，Lightning Flash 和Lightning Bolt 7 產生的待定醫院客戶數量比2020 年要多。我們歷史上的任何其他發射。目前，醫院已收到超過 1,000 份正在申請批准 Lightning Flash 或 Lightning Bolt 7 的申請。

In order to be under submission for approval, a specific physician or a group of physicians must champion bringing the product into the hospitals. Importantly, the majority of these physicians represent new customers to our thrombectomy products. Even further, we expect many additional hospital submissions over the next few quarters.%.

為了提交批准，特定的醫生或一組醫生必須支持將該產品引入醫院。重要的是，這些醫生中的大多數代表了我們血栓切除產品的新客戶。更進一步，我們預計未來幾個季度會有更多醫院提交材料。%。

Historically, once the submission process starts at a hospital, we have been extremely successful in getting our products through these approval processes. We are just getting started with Lightning Flash and Lightning Bolt 7. Our commercial team's execution of our strategy for Lightning Flash and Lightning Bolt 7 is incredible. We have a clear strategy to reach the majority of the 800,000 annual venous and arterial patients in the United States over the next 5-plus years, and we are convinced computer-aided thrombectomy is the way forward.

從歷史上看，一旦醫院開始提交流程，我們就非常成功地讓我們的產品通過這些審批流程。我們剛剛開始使用 Lightning Flash 和 Lightning Bolt 7。我們的商業團隊對 Lightning Flash 和 Lightning Bolt 7 戰略的執行令人難以置信。我們制定了明確的戰略，在未來 5 年多的時間裡覆蓋美國每年 800,000 名靜脈和動脈患者中的大多數，並且我們相信計算機輔助血栓切除術是前進的方向。

Our neuro business also had a strong quarter, and I saw firsthand this momentum at the Society of NeuroInterventional Surgery Conference yesterday in San Diego. The outstanding early results we are seeing with RED 72, with inner catheter SENDit technology foreshadow an exciting period for our stroke franchise. This early feedback suggests SENDit could prove to be the most important technology ever launched, addressing the most challenging part of stroke intervention. Safe, fast and repeatable trackability around the ophthalmic artery to the face of the clot. We believe RED 72 with SENDit represents the premium aspiration catheter and is as differentiated in innovation for the front end of the stroke intervention as Thunderbolt could be for clot removal once the catheters track to the face of the clot.

我們的神經業務也有一個強勁的季度，我昨天在聖地亞哥神經介入外科協會會議上親眼目睹了這種勢頭。我們在 RED 72 上看到的出色的早期結果以及內導管 SENDit 技術預示著我們的中風特許經營權將迎來一個激動人心的時期。這一早期反饋表明，SENDit 可能是有史以來推出的最重要的技術，可解決中風乾預中最具挑戰性的部分。安全、快速且可重複地追踪眼動脈周圍至凝塊表面。我們相信帶有 SENDit 的 RED 72 代表了優質抽吸導管，並且在中風乾預前端的創新方面具有差異化，就像一旦導管追踪到凝塊表面，Thunderbolt 就可以去除凝塊一樣。

We have seen positive share shift with this technology for the last 2 quarters and expect even more meaningful share shift in stroke in the quarters ahead leading to a dominant share of the U.S. stroke market over the next 3 to 4 quarters.

我們在過去兩個季度中看到了這項技術的積極份額變化，並預計未來幾個季度中風領域的份額變化將更加有意義，從而在未來 3 到 4 個季度佔據美國中風市場的主導份額。

Launching RED 72 with SENDit means we don't have to wait for Thunderbolt to see real share gains and market growth in stroke. And this technology only furthers our enthusiasm and confidence in Thunderbolt once it is cleared.

與 SENDit 一起推出 RED 72 意味著我們不必等待 Thunderbolt 就能看到真正的份額增長和市場增長。而這項技術一旦被清除，只會進一步增強我們對 Thunderbolt 的熱情和信心。

Internationally, we are seeing early success with the launch of our first-generation computer-aided products in Europe, and we have plans to expand access to our most advanced thrombectomy products to our international vascular teams over the next few years. In addition, our international teams and partners also see enormous potential to further expand our leadership in stroke intervention outside the U.S. with SENDit and Thunderbolt over the coming years.

在國際上，我們在歐洲推出第一代計算機輔助產品，取得了早期成功，並且我們計劃在未來幾年內向我們的國際血管團隊擴大使用我們最先進的血栓切除產品的機會。此外，我們的國際團隊和合作夥伴還看到了未來幾年通過 SENDit 和 Thunderbolt 進一步擴大我們在美國以外的中風乾預領域的領導地位的巨大潛力。

Turning to Immersive Healthcare. I am excited about the additional progress we've made during the quarter working with the Department of Veterans Affairs and key private healthcare partners. We're hitting important milestones together as we monitor the clinical success of our VR platform across myriad applications in physical rehabilitation, mental and cognitive health.

轉向沉浸式醫療保健。我對本季度我們與退伍軍人事務部和主要私人醫療保健合作夥伴合作取得的額外進展感到興奮。當我們監控 VR 平台在身體康復、心理和認知健康領域的無數應用的臨床成功時，我們正在共同實現重要的里程碑。

Before I turn the call over to Maggie, I want to say that we recognize expectations for our business are high. In fact, we had very high expectations for ourselves. We have a lot of confidence and our ability to succeed in the near term while we navigate agitated competitive reactions. We also believe in expediting the inevitable. And so we are laying the foundation to help all patients who can benefit from our thrombectomy products.

在將電話轉給瑪吉之前，我想說我們認識到對我們業務的期望很高。事實上，我們對自己抱有很高的期望。我們充滿信心，也有能力在短期內取得成功，同時應對激烈的競爭反應。我們也相信加速不可避免的事情。因此，我們正在奠定基礎，以幫助所有可以從我們的血栓切除產品中受益的患者。

Our current year guidance is a guidepost to near-term success, but it's just the first year within the next 5-plus year journey. We are paying a lot of attention to the guideposts and success over this longer period, and I believe this visibility we have to the larger patient opportunity is clearer to us now than it has ever been, owing to the feedback we're getting on Lightning Flash, Lightning Bolt 7 and RED 72 SENDit. That visibility gives us increasing confidence that we will continue to deliver strong revenue growth, gross margin expansion and significant profitability and cash flow over the foreseeable future.

我們今年的指導是近期成功的路標，但這只是未來五年多旅程的第一年。我們非常關注這段較長時期內的指導方針和成功，我相信，由於我們在閃電網絡上得到的反饋，我們現在比以往任何時候都更清楚地了解更大的患者機會閃光、Lightning Bolt 7 和RED 72 SENDit。這種可見性使我們越來越有信心，我們將在可預見的未來繼續實現強勁的收入增長、毛利率擴張以及顯著的盈利能力和現金流。

I'll now turn the call over to Maggie to go over our financial results for the second quarter of 2023.

我現在將電話轉給 Maggie，討論我們 2023 年第二季度的財務業績。

Thank you, Adam. Good afternoon, everyone. Today, I will discuss the financial results for the second quarter of 2023. Financial results on this call for revenue and gross margin are on a GAAP basis, while operating expenses and operating income are on a non-GAAP basis. The corresponding GAAP measures and a reconciliation of GAAP to non-GAAP financial measures are provided in our posted press release.

謝謝你，亞當。大家下午好。今天，我將討論 2023 年第二季度的財務業績。本次電話會議中的收入和毛利率是基於 GAAP 基礎上的財務結果，而運營費用和運營收入是基於非 GAAP 基礎上的。我們發布的新聞稿中提供了相應的 GAAP 衡量標準以及 GAAP 與非 GAAP 財務衡量標準的調節表。

For the second quarter ended June 30, 2023, our total revenues were $261.5 million, an increase of 25.5% reported and 25.5% in constant currency compared to the second quarter of 2022. Our geographic mix of sales in the quarter was 71.4% U.S. and 28.6% international. U.S. reported growth of 32% and our international regions increased 11.7% reported and 11.6% in constant currency. The sequential growth of 8.3% was primarily driven by continued momentum in our U.S. Vascular thrombectomy business as well as growth in neuro thrombectomy business across all regions.

截至2023 年6 月30 日的第二季度，我們的總收入為2.615 億美元，與2022 年第二季度相比，報告增長25.5%，按固定匯率計算增長25.5%。本季度我們的銷售地域組合為71.4% 美國和28.6% 國際化。美國報告增長 32%，國際地區報告增長 11.7%，按固定匯率計算增長 11.6%。 8.3% 的環比增長主要得益於我們美國血管血栓切除術業務的持續增長勢頭以及所有地區神經血栓切除術業務的增長。

Moving to revenue by franchise. Revenue from our vascular business grew to $152.7 million in the second quarter of 2023, an increase of 23.6% reported and 23.7% in constant currency compared to the same period last year, driven by a 50% year-over-year growth in U.S. thrombectomy and a relatively flat year-over-year for the rest of our global Vascular business.

轉向特許經營收入。受美國血栓切除術同比增長 50% 的推動，我們的血管業務收入在 2023 年第二季度增長至 1.527 億美元，與去年同期相比，報告增長 23.6%，按固定匯率計算增長 23.7%我們的全球其他血管業務同比相對持平。

Revenue from our Neuro business was $108.8 million in the second quarter of 2023, an increase of 28.3% reported and 28.1% in constant currency compared to the same period a year ago, driven by new products in the U.S., Europe and Asia Pacific.

2023 年第二季度，我們的神經業務收入為 1.088 億美元，在美國、歐洲和亞太地區新產品的推動下，與去年同期相比增長了 28.3%，按固定匯率計算增長了 28.1%。

Gross margin for the second quarter of 2023 is 63.8% compared to 64.3% for the second quarter of 2022 and 62.6% last quarter. The sequential improvement is in line with our expectations, driven by higher thrombectomy mix and ramping up new product launches productivity, offsetting inflation headwinds.

2023 年第二季度的毛利率為 63.8%，而 2022 年第二季度為 64.3%，上一季度為 62.6%。在血栓切除術組合增加和新產品發布效率提高、抵消通脹不利因素的推動下，連續改善符合我們的預期。

As our second quarter gross margin still reflects some Lightning start-up costs from the prior quarter, our operation team continues to execute well to support the increasing demand and we expect further gross margin expansion in the second half of 2023.

由於我們第二季度的毛利率仍然反映了上一季度的一些閃電啟動成本，我們的運營團隊繼續表現良好，以支持不斷增長的需求，我們預計 2023 年下半年毛利率將進一步擴大。

Now on to our non-GAAP operating expenses, which exclude the amortization of acquired intangible assets of $2.4 million, $1.8 million and $2.4 million for this quarter, for the same quarter last year, and last quarter, respectively.

現在來談談我們的非公認會計準則運營費用，其中不包括本季度、去年同季度和上季度分別為 240 萬美元、180 萬美元和 240 萬美元的收購無形資產攤銷。

Total operating expense for the quarter was $146.6 million or 56.1% of revenue compared to $132.4 million or 63.5% of revenue for the same quarter last year and $140.7 million or 58.3% of revenue last quarter.

本季度總運營費用為 1.466 億美元，佔收入的 56.1%，去年同期為 1.324 億美元，佔收入的 63.5%，上季度為 1.407 億美元，佔收入的 58.3%。

Our Research and Development Expenses for Q2 2023 were $21.5 million compared to $19.6 million for Q2 2022 and $20 million for last quarter. SG&A expenses for Q2 2023 were $125.1 million or 47.8% of revenue compared to $112.8 million or 54.2% of revenue for Q2 2022 and $120.7 million or 50% of revenue last quarter.

我們 2023 年第二季度的研發費用為 2150 萬美元，而 2022 年第二季度為 1960 萬美元，上季度為 2000 萬美元。 2023 年第二季度的銷售管理及行政費用為1.251 億美元，佔收入的47.8%，而2022 年第二季度為1.128 億美元，佔收入的54.2%，上一季度為1.207 億美元，佔收入的50%。

We recorded operating income of $20.3 million or [7.8%] of revenue in the second quarter of 2023 compared to operating income of $1.6 million for the same period last year and operating income of $10.4 million or 4.3% of revenue last quarter. While we continue to invest in long-term growth and effectively allocate resources and investment to support new product launches, I'm very pleased with our team's great execution and expect our operating margin expansion trend to continue in the second half of 2023 and beyond.

2023 年第二季度，我們的營業收入為 2030 萬美元，佔收入的 7.8%，而去年同期的營業收入為 160 萬美元，上季度的營業收入為 1040 萬美元，佔收入的 4.3%。在我們繼續投資於長期增長並有效分配資源和投資以支持新產品發布的同時，我對我們團隊的出色執行力感到非常滿意，並預計我們的營業利潤率擴張趨勢將在2023 年下半年及以後持續下去。

Turning to our cash flow and balance sheet. We ended the second quarter with a cash, cash equivalents and marketable securities balance of $221.1 million and no debt, which is an increase of $22 million from the last quarter. The sequential increase in cash is driven by an increase in profitability and improvements in working capital turns.

轉向我們的現金流和資產負債表。第二季度末，我們的現金、現金等價物和有價證券餘額為 2.211 億美元，沒有債務，比上季度增加了 2200 萬美元。現金的連續增長是由盈利能力的提高和營運資金周轉率的改善推動的。

And now I'd like to turn the call over to Jason to discuss our guidance.

現在我想將電話轉給 Jason 來討論我們的指導。

Thank you, Maggie, and good afternoon, everyone. We increased our 2023 revenue guidance to a range of $1.05 billion to $1.07 billion, which represents 24% to 26% growth over 2022 total revenue. We continue to expect growth in our global Vascular business to be slightly above this range and growth in our global Neuro business to be below this range for the full year 2023.

謝謝瑪吉，大家下午好。我們將 2023 年收入指導上調至 10.5 億美元至 10.7 億美元，比 2022 年總收入增長 24% 至 26%。我們仍然預計 2023 年全年我們的全球血管業務的增長將略高於此範圍，而我們的全球神經業務的增長將低於此範圍。

From a quarterly perspective, we expect growth in the United States to accelerate modestly from the record 32% growth we posted in the second quarter, while we expect our international growth to be mid-single digits in the third quarter due to seasonality and a challenging year-over-year comparison and reaccelerate to double-digit growth in the fourth quarter.

從季度角度來看，我們預計美國的增長將在第二季度創紀錄的 32% 增長基礎上小幅加速，而由於季節性和挑戰，我們預計第三季度的國際增長將達到中個位數。同比比較並在第四季度重新加速至兩位數增長。

In sum, we expect our global revenue to grow in the range of 23% to 25% in the third quarter on a year-over-year basis, accelerating to 30% cost growth in the fourth quarter.

總而言之，我們預計第三季度全球收入同比增長在 23% 至 25% 範圍內，第四季度成本增長加速至 30%。

Moving down the income statement. We expect both gross margins and non-GAAP operating margins to expand further as we move through the second half of 2023. We continue to target over 70% gross margins within a few years and over 10% operating margins by the end of 2023 with further expansion expected in subsequent years.

將損益表向下移動。我們預計，隨著 2023 年下半年的到來，毛利率和非 GAAP 營業利潤率將進一步擴大。我們繼續目標是在幾年內毛利率超過 70%，到 2023 年底營業利潤率超過 10%，並進一步提高預計將在隨後幾年進行擴張。

I will now turn the call back to Adam for closing remarks.

現在我將把電話轉回給亞當，讓他發表結束語。

Thank you, Jason, Maggie and Jee. I know I speak for the entire Penumbra team when I say that we are at a defining moment in our company's history, a moment almost 20 years in the making, where we can see clearly now how our innovation with computer-aided thrombectomy can help almost everyone with blood clots in their arteries and veins.

謝謝杰森、瑪吉和吉。我知道，當我說我們正處於公司歷史上的一個決定性時刻時，我代表整個Penumbra 團隊發言，這一時刻已經醞釀了近20 年，現在我們可以清楚地看到，我們的計算機輔助血栓切除術創新如何幫助幾乎所有患者每個人的動脈和靜脈都有血栓。

We fully understand how much work we have to do going forward. We have studied and learned from the best companies before us who have taken on market development and done it the right way. I can promise to vouch, myself, our entire Penumbra team, the physicians we will work with and the hospital systems are ready to take on this challenge. We are going to keep on trying until we reach our highest ground. The next 5-plus years will be hard work, but the most exciting part of the Penumbra journey. Thank you.

我們完全了解未來需要做多少工作。我們向之前最優秀的公司學習和學習，他們以正確的方式進行了市場開發。我可以保證，我本人、我們的整個 Penumbra 團隊、我們將合作的醫生以及醫院系統已準備好應對這一挑戰。我們將繼續努力，直到到達最高點。接下來的五年多將是艱苦的工作，但卻是半影之旅中最令人興奮的部分。謝謝。

Operator, we can now open the call to questions for the next 40 minutes.

接線員，我們現在可以開始接下來 40 分鐘的提問。

(Operator Instructions) Your first question is from the line of Bill Plovanic with Canaccord.

（操作員說明）您的第一個問題來自 Canaccord 的 Bill Plovanic。

Great. It's an impressive quarter. I'm trying to figure out where to start. But I think in the U.S. neuro, can you help us understand -- I mean, it sounds like the RED 72 with the SENDit is really surprising even you internally. Just kind of what's really going on there in terms of that adoption and then an update on the Thunderbolt? Do you expect to have that trial enrolled by the end of the year? Is that kind of still on track or get that out end of the year and then launch it in '24?

偉大的。這是一個令人印象深刻的季度。我正在想辦法從哪裡開始。但我認為在美國神經中，你能幫助我們理解嗎？我的意思是，聽起來帶有 SENDit 的 RED 72 甚至連你自己都感到驚訝。就 Thunderbolt 的採用和更新而言，到底發生了什麼？您希望在今年年底之前完成該試驗嗎？是仍在按計劃進行還是在今年年底完成，然後在 24 年推出？

Yes. Great questions, Bill. Thank you. Yes, the good news, I won't say that Red 72 with SENDit is surprising us. We've been in neuro for a long, long time. So we know it pretty well. But it is obviously very heartening for us. As you know, we have spent the better part of 20 years tackling this issue, the idea of trying to navigate catheters of the right size up to the intracranial circulation and up to M1 and beyond when necessary. And we've had some great products. We've had some struggles, obviously, a few years ago, but to have a product now that can track better than anything we've launched even in the updated XTRA FLEX is really exciting for the team and heartening. And frankly, the physicians have embraced it because if you can't get there, Thunderbolt doesn't matter. You have to be able to get there in a routine way, and that's a critical part of the procedure.

是的。很好的問題，比爾。謝謝。是的，好消息，我不會說帶有 SENDit 的 Red 72 讓我們感到驚訝。我們在神經領域已經有很長一段時間了。所以我們對此非常了解。但這對我們來說顯然是非常令人振奮的。如您所知，我們花了 20 年的大部分時間來解決這個問題，即嘗試將尺寸合適的導管引導至顱內循環，並在必要時引導至 M1 甚至更高。我們已經有了一些很棒的產品。顯然，幾年前我們遇到了一些困難，但現在擁有一款比我們推出的任何產品都更好的追踪產品，甚至在更新的 XTRA FLEX 中，這對團隊來說確實令人興奮和振奮。坦率地說，醫生們已經接受了它，因為如果你無法到達那裡，Thunderbolt 就沒有關係了。您必須能夠以常規方式到達那裡，這是該過程的關鍵部分。

I'm glad you asked about the Thunderbolt. Let me give you a little bit of an update. As I've mentioned in the past, the time line for that has been pushed out a touch. There are 2 reasons. The first is -- and we've mentioned this at the first sort of roughly 100 patients enrolled, took a little longer to enroll due to the required 8-hour window, but we have seen enrollment accelerate now as the trial has progressed, that's a really good sign.

我很高興您詢問有關 Thunderbolt 的問題。讓我向您提供一些最新情況。正如我過去提到的，這個時間表已經被推遲了一點。有兩個原因。第一個是——我們在第一批大約100 名患者入組時提到過這一點，由於所需的8 小時窗口，入組時間要長一些，但隨著試驗的進展，我們現在看到入組速度加快，那就是這是一個非常好的跡象。

The second reason, the FDA asked us to modify the safety end point from all serious adverse events of 24 hours to symptomatic ICH at 24 hours. This request and change has not stopped enrollment in any way, but it does increase the sample size a little by about 75 patients. This request was not related to anything specific to our trial or device but seems to be made in order to make our trial consistent with other stroke trials that are currently being run. And to our knowledge, those trials have also been pushed out for potentially similar reasons.

第二個原因，FDA要求我們將安全終點從24小時的所有嚴重不良事件修改為24小時的症狀性ICH。這一請求和變更並未以任何方式停止招募，但確實將樣本量增加了約 75 名患者。這一請求與我們的試驗或設備的任何特定內容無關，但似乎是為了使我們的試驗與當前正在進行的其他中風試驗保持一致。據我們所知，這些試驗也因可能類似的原因而被推遲。

We're finalizing the details with the FDA. And soon all that's done, we'll formally update this. But it might add another 12 months or so. That said, that allows us the time to really penetrate the market with 72 and SENDit, which, again, we don't have to wait for Thunderbolt to do that, and we have the opportunity to take significant share but equally importantly, or as importantly, grow the market with this premium product.

我們正在與 FDA 敲定細節。很快所有這些都完成了，我們將正式更新。但可能還會再延長 12 個月左右。也就是說，這使我們有時間通過​​ 72 和 SENDit 真正滲透市場，我們不必等待 Thunderbolt 這樣做，我們有機會獲得重要份額，但同樣重要的是，或者作為重要的是，利用這種優質產品來擴大市場。

So I think it's set up for a really good run. And you didn't ask this question, Bill, but I know you will have it as your first follow-up. So I'll -- if you don't mind, take the liberty of answering it first, and that is this slightly new timing, does not impact our projected numbers at all for 2023, 2024 or 2025. So I wanted to make sure that I preempted the question.

所以我認為它的設置非常好。比爾，你沒有問這個問題，但我知道你會把它作為你的第一個後續問題。所以，如果您不介意的話，請冒昧地先回答這個問題，這是一個稍微新的時間安排，根本不會影響我們 2023 年、2024 年或 2025 年的預計數字。所以我想確保我搶占了這個問題。

Good. Well, you preempted half the question. As you think of '23 guidance in the raise, it reflects the quarter not much more. And I'm kind of wondering how do we think about -- what are you including in the bottom end of the range and the top end of the range given the outperformance in the quarter and at least to our numbers, it doesn't seem like you're adding much in for the back half of the year.

好的。好吧，你搶先了一半的問題。當你想到 23 年的加薪指引時，它並沒有更多地反映該季度的情況。我有點想知道我們如何考慮——考慮到本季度的優異表現，至少從我們的數據來看，您在範圍的底端和高端中包括了什麼，似乎並沒有就像你在今年下半年增加了很多。

Yes. Thank you, Bill, for the question. It's a good question. So the first thing I'd say is that in our first 2 calls so far this year, we've raised our revenue guidance by about $60 million. I think that's about 3x the amount our results exceeded consensus expectations cumulatively over these first 2 quarters. But if you look forward, I think it's worth noting a couple of things.

是的。謝謝比爾提出這個問題。這是一個好問題。因此，我要說的第一件事是，在今年迄今為止的前兩次電話會議中，我們已將收入指導提高了約 6000 萬美元。我認為這大約是前兩個季度我們的業績超出共識預期的三倍。但如果你展望未來，我認為有幾件事值得注意。

Our updated guidance sort of -- what our updated guidance accounts for and anticipates as well as maybe what it doesn't fully factor in. First, we'd expect our U.S. business will grow faster in the second half of the year compared to the first. We did mention that in our prepared remarks. That's largely driven obviously from Flash, Bolt and SENDit.

我們更新的指導意見有點——我們更新的指導意見解釋和預測的內容，以及可能沒有完全考慮的內容。首先，我們預計我們的美國業務在今年下半年將比去年同期增長更快。第一的。我們在準備好的發言中確實提到了這一點。這很大程度上顯然是由 Flash、Bolt 和 SENDit 推動的。

It also reflects our expectation that growth in peripheral thrombectomy, both in the U.S. and globally, will accelerate in the second half of the year. The last thing I'd say is we're excited about what we're seeing in the hospital submission process with an unprecedented number of largely new accounts pending.

這也反映了我們的預期，即美國和全球外周血栓切除術的增長將在今年下半年加速。我要說的最後一件事是，我們對在醫院提交過程中看到的情況感到興奮，等待處理的賬戶數量空前，大部分是新賬戶。

The timing, obviously, of these processes is variable. It can take anywhere from a few months to up to 9 months plus. And I would say we have been appropriate about how we're factoring this into our guidance at this stage. And overall, we think we have a lot to look forward to the balance of this year and into the next year.

顯然，這些過程的時間是可變的。可能需要幾個月到九個月以上的時間。我想說的是，我們在現階段如何將這一點納入我們的指導中是適當的。總的來說，我們認為今年和明年的平衡有很多值得期待的地方。

Your next question is from the line of Robbie Marcus with JPMorgan.

您的下一個問題來自摩根大通的羅比·馬庫斯。

Great. Maybe to start on peripheral vascular. Looks like U.S. was up 50%. The rest of the business was flat. Maybe you could just walk through what's going on there trend-wise? Is there a headwind or slowdown in coils, anything outside the U.S. to point to the vascular business was a little bit below the Street. So just trying to understand great U.S. growth, but what happened to the rest of the vascular business?

偉大的。也許要從外周血管開始。看起來美國上漲了50%。其餘業務持平。也許您可以從趨勢角度了解一下那裡正在發生的事情？線圈行業是否遇到逆風或放緩，美國以外任何表明血管業務的因素都略低於華爾街。因此，我只是想了解美國的巨大增長，但其他血管業務發生了什麼？

Yes. Thanks for the question, Robbie. Well, overall, we think the Vascular business had a really strong quarter. Obviously, the U.S. -- you mentioned the U.S. Peripheral Thrombectomy business was up 50%. The U.S. total Thrombectomy business, stroke was up over 40%. Internationally, there are obviously both coils and thrombectomy is really generally fairly early. We have Lightning 12 and Lightning 7 just getting started internationally, and there's a lot of work to do. I wouldn't say there is anything untoward going on. We just don't have all of our premium products internationally. And in the United States, it's really expected to drive that growth. So I think the guidance reflects what we expect from our Vascular business, really strong accelerating growth, especially driven from the U.S. market.

是的。謝謝你的提問，羅比。嗯，總的來說，我們認為血管業務的季度表現非常強勁。顯然，美國——您提到美國外周血栓切除術業務增長了 50%。美國中風血栓切除術業務總量增長了 40% 以上。在國際上，顯然有彈簧圈和血栓切除術通常相當早。我們的閃電 12 和閃電 7 剛剛在國際上啟動，還有很多工作要做。我不會說有什麼不愉快的事情發生。我們只是沒有在國際上擁有所有優質產品。在美國，它確實有望推動這種增長。因此，我認為該指導反映了我們對血管業務的期望，即真正強勁的加速增長，尤其是在美國市場的推動下。

Yes. And to be honest with you, we look at that as the opportunity as we bring these products, particularly Flash and Lightning Bolt 7 and RED 72 with SENDit and Thunderbolt, to those markets because then we'll have the opportunity to have a similar growth continue in the international markets. So it's really driven by the innovation and the technology that has always defined us.

是的。老實說，當我們將這些產品（特別是 Flash 和 Lightning Bolt 7 以及帶有 SENDit 和 Thunderbolt 的 RED 72）引入這些市場時，我們將其視為機遇，因為這樣我們將有機會實現類似的增長繼續進軍國際市場。因此，它實際上是由始終定義我們的創新和技術驅動的。

And then maybe to just hit on some of the sequencing. You gave us, I believe it was 23% to 25% growth in third quarter, correct me if I'm wrong, and greater than 30%, in fourth quarter. That's lower and higher than what the Street has for third and fourth quarter. So maybe just walk us through some of the puts and takes there and your confidence in that greater than 30% number in fourth quarter.

然後也許只是偶然發現一些排序。你告訴我們，我相信第三季度的增長是 23% 到 25%，如果我錯了，請糾正我，第四季度的增長超過 30%。這比華爾街第三季度和第四季度的數據要低或要高。因此，也許請向我們介紹一些看跌期權和看跌期權，以及您對第四季度超過 30% 的數字的信心。

Yes. Thanks for the question, Robbie. And we did point that out. As you know, we don't typically guide quarterly, but we thought it was important to recognize the third quarter, I think the way that the third quarter had been sort of modeled from a consensus perspective, underappreciated the momentum in the United States and the international markets was just a little bit too high. So that's the put and the take in the third quarter.

是的。謝謝你的提問，羅比。我們確實指出了這一點。如您所知，我們通常不會按季度提供指導，但我們認為認識到第三季度很重要，我認為從共識角度對第三季度進行建模的方式低估了美國的勢頭，國際市場的價格有點太高了。這就是第三季度的看跌期權和賣出期權。

I think where -- we expect to get the growth, not just next quarter, but for a while as the United States market, I think that's where folks want to see our growth because that's where Flash and Bolt are exclusively at this point. And in the fourth quarter, the comps on a year-over-year basis internationally are just not the same as they are in the third. So as we mentioned, expect double-digit growth. So again, that's compounded with the U.S. business that we'll still have plenty of momentum, obviously, as we've said coming out of the second and the third quarters.

我認為，我們期望獲得增長，不僅僅是下個季度，而是在美國市場一段時間內，我認為人們希望看到我們的增長，因為這是 Flash 和 Bolt 目前唯一的市場。在第四季度，國際上的同比情況與第三季度不同。正如我們提到的，預計會有兩位數的增長。因此，與美國業務相結合，我們顯然仍將擁有充足的動力，正如我們在第二季度和第三季度所說的那樣。

Your next question is from the line of Larry Biegelsen with Wells Fargo.

您的下一個問題來自富國銀行的拉里·比格爾森 (Larry Biegelsen)。

Congrats on a nice quarter here. Adam, just two clarification questions upfront. The Thunder delay of 12 months, what's the basis there? So filing -- was it filing by the end of '23, does that pushed out to filing now end of '24?

恭喜您度過了一個愉快的季度。亞當，請先澄清兩個問題。雷霆延期12個月，有何依據？那麼，是在 23 年底提交的，還是推遲到 24 年底提交的？

Yes. We'll get all the specifics -- timing of that out when I told you when finished up with -- but generally, I wanted to quantify it with the extended of about 12 months. The most important thing, again, really, really want to stress this. We are not with -- the performance, and you can see it in our numbers for the second quarter in a row, the performance of our Neuro business is not waiting for Thunderbolt.

是的。我們會得到所有的細節——當我告訴你什麼時候完成的時候——但總的來說，我想用大約 12 個月的時間來量化它。最重要的是，真的、真的想再次強調這一點。我們沒有——業績，你可以從我們連續第二季度的數據中看到，我們的 Neuro 業務的業績並不等待 Thunderbolt。

We have this unbelievable premium product that is capturing share. It is the talk of SNIS that we were just at. So we are in really, really good shape.

我們擁有這款令人難以置信的優質產品，正在搶占市場份額。我們剛才正在討論 SNIS。所以我們的狀態非常非常好。

And then on top of that, when Thunderbolt comes, we get to deal with the other part of the procedure, not just getting there, but making sure that in every case, we can get the clot out.

最重要的是，當 Thunderbolt 到來時，我們要處理手術的其他部分，不僅僅是到達那裡，還要確保在每種情況下，我們都能將血栓取出。

So I want everyone to be very, very clear, and I'm -- appreciate your question, Larry, that the setup for us the ability to go after both parts of this procedure now are critical. And I think everyone knows how important trackability is.

所以我希望每個人都非常非常清楚，拉里，我感謝你的問題，我們現在能夠完成該程序的兩個部分的能力至關重要。我想每個人都知道可追踪性有多麼重要。

It was a topic for quite a while around us in our stroke gathers. So the fact that we have a product that is doing such an amazing job in taking such share leading to my comment that I think we'll get the dominant share is great. And then to add Thunderbolt on top and to see how that will continue the growth curve of our stroke businesses is a great sign. So thank you for the question.

在我們的中風收集中，這是我們周圍很長一段時間的一個話題。因此，事實上，我們的產品在佔據如此大的份額方面做得非常出色，這導致我評論說，我認為我們將獲得主導份額，這真是太棒了。然後將 Thunderbolt 添加到頂部，看看這將如何延續我們中風業務的增長曲線，這是一個很好的跡象。謝謝你的提問。

Yes. Adam, I'm just wondering to follow up on Robbie's question, Embolization has been a good business for you, growing mid-teens at least. What is going to do this quarter? And I'm wondering if the sales force is perhaps distracted launching 2 products. And just -- I just want to sneak one in on vasc, it seems hard to get to -- how vascular is going to grow faster than neuro for the year, given the first half, Neuro has grown so much faster than Vascular.

是的。亞當，我只是想跟進羅比的問題，栓塞術對你來說是一筆好生意，至少在十幾歲的時候是這樣。這個季度要做什麼？我想知道銷售人員是否可能因為推出兩種產品而分心。只是 - 我只是想偷偷地談談血管，這似乎很難 - 今年血管的增長將如何比神經更快，考慮到上半年，神經的增長比血管快得多。

Yes. Really good follow-up questions. The first one on the coils, we're already in a majority market share with coil. So by definition, that is going to slow down compared to the beginning of the 2 most significant launches in our company's history. So I think the numbers are fairly obvious when you do that. And don't get me wrong, everyone is proud of our coils. They do great work and have a significant clinical benefit. But just by definition, that's going to happen.

是的。非常好的後續問題。第一個關於線圈的產品，我們已經佔據了線圈的大部分市場份額。因此，根據定義，與我們公司歷史上兩次最重要的發布相比，這將會放緩。所以我認為當你這樣做時，數字是相當明顯的。不要誤會我的意思，每個人都為我們的線圈感到自豪。他們做了出色的工作並具有顯著的臨床效益。但根據定義，這種情況將會發生。

The question around Vascular, I think we answered it in the script. We have way more hospitals coming on board with Lightning Flash and Lightning Bolt than we already have. We're closer to the beginning, I made a pretty specific comment that we have well over 1,000 submissions in the U.S. alone for Flash and Bolt. We are way -- and these are mostly new customers and that process as it plays out, will obviously drive. And then this is folks who have seen it, use it once, going through the submission process at the hospital. The scale of this is different than any other product we've ever launched in our company's history.

關於血管的問題，我想我們在劇本中已經回答了。與現有的相比，我們有更多的醫院加入了 Lightning Flash 和 Lightning Bolt。我們已經接近開始了，我做了一個非常具體的評論，僅在美國，我們就收到了超過 1,000 份關於 Flash 和 Bolt 的提交。我們是這樣的——這些大多是新客戶，這個過程隨著它的展開，顯然會推動。然後這些人已經看過它，使用過它一次，在醫院完成提交過程。其規模與我們公司歷史上推出的任何其他產品都不同。

And I just wanted people to understand that. And that means it's -- it might not happen in 1 day, but it's happening. And I got to give -- it's a testament to the sales team for doing the work to get that going, but it also to just extraordinary innovation that is driving that many new customers to want to use this product. So I think when you do the math around that, the question around vascular growth takes care of itself.

我只是想讓人們理解這一點。這意味著它可能不會在一天內發生，但它正在發生。我必須給予——這是對銷售團隊為實現這一目標所做的工作的證明，但它也證明了非凡的創新正在推動許多新客戶想要使用該產品。所以我認為，當你對此進行數學計算時，關於血管生長的問題就迎刃而解了。

Yes. The only thing I would add is just from a number standpoint, Larry. I think Vascular globally was about 58% of our total revenue. That will climb in the third quarter a little bit, perhaps slightly below 60%. And then we likely will be over 60% of our business Vascular globally in the fourth quarter.

是的。我唯一要補充的是從數字的角度來看，拉里。我認為全球血管業務約占我們總收入的 58%。第三季度這一比例將略有上升，可能略低於 60%。然後，到第四季度，我們的全球血管業務可能會超過 60%。

Your next question comes from the line of Margaret Kaczor with William Blair.

你的下一個問題來自瑪格麗特·卡佐爾和威廉·布萊爾的對話。

I wanted to really follow up on two pieces. So one, get a sense of the scale, I guess, of the 1,000 active hospital submission for approval for Flash and Bolt. And I'm not sure a few people are willing to give us what number of hospitals, I guess, you're at today, relative to the hospitals that you're targeting and that 1,000 plus as we look out versus the potential accounts, right?

我想真正跟進兩件作品。因此，我想了解一下 1,000 家積極提交 Flash 和 Bolt 批准申請的醫院的規模。我不確定有多少人願意向我們透露您今天所在的醫院數量，相對於您所瞄準的醫院，以及我們與潛在賬戶相比的 1,000 多家醫院，正確的？

And then a similar question on the adoption curve of those maybe that have trialed Flash and Bolt. Can you give us a sense of kind of their scale? Is it month -- this month 1, try a few cases, kind of put it to the side, bring it on? Or is it kind of inflection has reached relatively quickly just as we go on throughout the year, it will give us a sense of growth?

然後是關於那些可能嘗試過 Flash 和 Bolt 的人的採用曲線的類似問題。您能否讓我們了解一下它們的規模？是月嗎——這個月1號，嘗試幾個案例，有點把它放在一邊，帶上它？或者說是一種拐點已經相對較快地達到了，就像我們全年持續進行一樣，它會給我們一種成長的感覺？

Yes. Really great question. Let me do my best to sort of answer it. The answer of how -- what is well over 1,000 submissions mean? The best way to talk about it is it's we're closer to the beginning of this launch than we are to the end of this launch, okay? That's the right way to sort of put it in a frame. We have more to go than has already been accomplished.

是的。真是個好問題。讓我盡力回答一下吧。答案是——遠遠超過 1,000 份提交意味著什麼？談論它的最好方式是，我們距離本次發布的開始比距離本次發布的結束更近，好嗎？這是將其放入框架中的正確方法。與已經完成的工作相比，我們還有更多的工作要做。

How fast somebody ramps up? You can't really -- other than maybe 1 or 2 cases, you can't really use a product without it being formally brought on through this process. So that's the gating item. And so we have a lot to go to get that going.

一個人的提升速度有多快？你不能真的——除了一兩個案例之外，如果沒有通過這個過程正式引入產品，你就不能真正使用它。這就是門控項目。因此，為了實現這一目標，我們還有很多工作要做。

Once somebody does bring it on, so far, our experience has been that it's a pretty sticky business. And I think that's partly what is driving new customers that we haven't had before to be so interested because word of mouth, physicians talking to physicians, sharing their experiences that has been very sticky. So you tend to have a lot of physicians wanting this to happen as fast as possible so they can start to get using this.

到目前為止，一旦有人確實推出了它，我們的經驗是，這是一個非常棘手的業務。我認為這在一定程度上推動了我們以前從未有過的新客戶如此感興趣，因為口口相傳、醫生與醫生交談、分享他們的經驗，這些都是非常有粘性的。因此，很多醫生往往希望這種情況盡快發生，以便他們可以開始使用它。

And that is why you hear the confidence we have about not just the rest of this year, but going into the prior -- the future years as well. We just have not had an experience like this with -- where the innovative -- the technology itself is driving a scale of adoption or interest like we have seen.

這就是為什麼你會聽到我們不僅對今年剩餘時間充滿信心，而且對前幾年和未來幾年也充滿信心。我們只是沒有經歷過這樣的經歷——創新——技術本身正在推動我們所看到的大規模採用或興趣。

Okay. And then you've referenced yourself kind of the 30%-plus growth as we get into Q4. I know the comps obviously this year are easier than they will be in '24 but how should we think about that? Because you've got the (inaudible) mid-teens, all the commentary you're saying is so positive, right, both on Vascular and neuro. And it just feels like it's a pretty rapid deceleration, which is not what the commentary is suggesting. So maybe just clear up those 2 comments versus opportunity.

好的。然後，您提到了進入第四季度時增長了 30% 以上。我知道今年的比賽顯然比 24 年的比賽要容易，但我們應該如何考慮這一點？因為你已經（聽不清）十幾歲了，所以你所說的所有評論都是如此積極，對吧，無論是關於血管還是神經。只是感覺減速相當快，這並不是評論所暗示的。因此，也許只需澄清這兩條評論與機會即可。

Yes. It's still summertime. So I hope you don't mind it. I'm not going to give guidance for 2024 in the middle of summer for 2023. I think you can take our commentary and what we're sharing about what we have in front of us as the best sign of our confidence. To quantify that down into a percentage is a tough premature at this point. But that's not in any way to not be enthusiastic about all 3 of those products that we're currently launching.

是的。現在還是夏天。所以我希望你不要介意。我不會在仲夏時節就 2023 年給出 2024 年的指導。我認為您可以將我們的評論以及我們所分享的關於我們面前的情況視為我們信心的最佳標誌。目前將其量化為百分比還為時過早。但這並不意味著我們對我們目前推出的所有 3 種產品不感興趣。

Your next question is from the line of Joanne Wuensch from Citi.

您的下一個問題來自花旗銀行的 Joanne Wuensch。

This is Anthony on for Joanne. I think last quarter, you called out supply as maybe a headwind or gating factor to Flash update. Just curious if that was the case this quarter again. And then just as a quick follow-up, can you just talk about adoption trends you're seeing with Flash and peak PE cases versus DVT?

這是安東尼替喬安妮上場。我認為上個季度，您稱供應可能是閃存更新的阻力或限制因素。只是好奇本季度是否會再次出現這種情況。作為快速跟進，您能否談談您所看到的 Flash 和峰值 PE 案例與 DVT 的採用趨勢？

Yes, great question. Thank you. We did not have to really focus on supply. I mean don't get me wrong. The operations team is working incredibly hard to ensure we don't have that issue. And I very -- particularly at the beginning of the quarter, I said we didn't expect that to limit us. The real -- and we're hoping to keep ahead of that curve going forward, and the team is working diligently.

是的，很好的問題。謝謝。我們不必真正關注供應。我的意思是不要誤會我的意思。運營團隊正在非常努力地工作，以確保我們不會遇到這個問題。我非常 - 特別是在本季度初，我說過我們並不認為這會限制我們。真實的——我們希望在未來保持領先地位，團隊正在努力工作。

As it relates to PE versus DVT, we're not really seeing a difference. There are, obviously, competitive reactions and physicians who are going to have different viewpoints to start. But what we're seeing is both of those areas, whether it's PE case or DVT case are incredibly successful and physicians are responding to that. Some might start with one and then navigate to the other and vice versa. There is not a trend that I would yet point out. That one is better or different than the other at this point. And I don't expect that to be the case given the sheer volume of cases and the success we're seeing.

由於 PE 與 DVT 相關，我們並沒有真正看到差異。顯然，存在競爭性反應，醫生們也會有不同的觀點。但我們看到的是，無論是 PE 病例還是 DVT 病例，這兩個領域都取得了令人難以置信的成功，醫生正在對此做出反應。有些人可能會從一個開始，然後導航到另一個，反之亦然。目前還沒有我要指出的趨勢。在這一點上，那個比另一個更好或不同。考慮到案件的數量和我們所看到的成功，我預計情況不會是這樣。

Your next question is from the line of Matthew O'Brien with Piper Sandler.

您的下一個問題來自 Matthew O'Brien 和 Piper Sandler。

Maybe just to tease out this back half acceleration because as I look at the stock down about 5% in the aftermarket, I'm sure some of it's Thunderbolt, but probably more on the Vascular business, even though the U.S. was awesome. So because we have a bigger second half ramp. And Jason, you know all about the big second half ramps and concerns you around those what's assumed as far as hitting the Q3 acceleration, Q4 acceleration with the Vascular business in terms of these active submissions and converting them to users or existing hospitals bulking up their utilization?

也許只是為了梳理一下後半段的加速，因為當我看到該股票在售後市場下跌了約 5% 時，我確信其中一些是 Thunderbolt 的，但可能更多的是血管業務，儘管美國很棒。因為我們下半場坡道更大。傑森（Jason），您知道下半年的大幅增長，並擔心您對血管業務在這些積極提交的情況下達到第三季度加速、第四季度加速的假設，並將其轉化為用戶或現有醫院，以擴大其業務利用率？

Yes. I'll maybe take the front end of that, Matt. Thanks for the question and then Adam can clean up after me. The third quarter growth -- pretty strong range. The guidance, obviously, in the third quarter, at the top end 25% off of -- a pretty strong third quarter of last year. So we think that, that will be driven by the United States, it's hard to accelerate off of the growth in the United States that we put up in the second quarter. We think we can at least do that growth and maybe show some acceleration in the third.

是的。我也許會先講這個，馬特。謝謝你的提問，然後 Adam 就可以幫我清理了。第三季度的增長相當強勁。顯然，第三季度的指導比去年相當強勁的第三季度低了 25%。因此，我們認為，這將由美國推動，我們在第二季度提出的美國經濟增長很難加速。我們認為我們至少可以實現這種增長，並且可能在第三個階段表現出一些加速。

And we also commented and you asked about it, and I'll turn it to Adam to answer more thoroughly about the submission process. But when I say we've been appropriate with respect to what we factored in, I think that you can read that to mean that we're being appropriate. We're not factoring in things that we don't have control over timing or other things, notwithstanding that when the submission process starts, we have a history of having a high degree of success getting through positively.

我們也發表了評論，您也提出了這個問題，我會將其交給 Adam，以更徹底地回答有關提交過程的問題。但是，當我說我們考慮的因素是適當的時，我認為您可以將其理解為我們是適當的。我們不會考慮我們無法控制時間或其他事情的因素，儘管當提交過程開始時，我們有積極通過的高度成功的歷史。

Yes. I don't -- I think you answered that really well. I don't have anything specific to answer other than -- we've always looked at our guidance and done it as very realistic, and making sure that we're giving the complete information around this. That's why we're sharing you the number of submissions in hospitals for both Flash and Bolt and some of the commentary around SENDit because that also is going to be a pretty significant part of our Neuro growth for quite a while.

是的。我不——我認為你回答得很好。我沒有什麼具體的問題可以回答，除了——我們一直在審視我們的指導意見，並把它做得非常現實，並確保我們提供有關這方面的完整信息。這就是為什麼我們要與您分享醫院中針對 Flash 和 Bolt 的提交數量以及一些有關 SENDit 的評論，因為這也將在相當長的一段時間內成為我們 Neuro 發展的一個非常重要的部分。

And just lastly, I'll just add on to those comments. Usually, as you probably know, Matt, the fourth quarter or the third quarter internationally tends to be a bit seasonal and in the fourth quarter, the strongest quarter, that's reflected in this guidance. We -- as a matter of fact, put our expectations for growth internationally for both the third and the fourth quarters, that's reflective of that sort of normal seasonal trends. And what we know about our business internationally can comment it with what we expect in the United States from those 3 products we've talked so much about on this call.

最後，我將補充這些評論。通常，正如您可能知道的那樣，馬特，國際上的第四季度或第三季度往往有點季節性，而第四季度是最強勁的季度，這一點反映在本指引中。事實上，我們對第三季度和第四季度的國際增長做出了預期，這反映了這種正常的季節性趨勢。我們對國際業務的了解可以用我們在美國對我們在這次電話會議上討論過的這 3 種產品的期望來評價。

Got it. Appreciate that feedback. One more quick one. Just -- and everybody is talking about looking ahead in terms of all these new active centers that are reviewing -- the new products, but what about ones that have adopted that have got through the VACs, what are you seeing in terms of utilization trends? And then specifically reorder rates. Are you seeing 90-plus reorder rates from these accounts?

知道了。感謝您的反饋。再來一張快點。只是——每個人都在談論展望未來，所有這些新的活躍中心正在審查——新產品，但是那些已經通過 VAC 的產品怎麼樣，你在利用率趨勢方面看到了什麼？ ？然後是具體的再訂購率。您是否發現這些帳戶的再訂購率超過 90？

Yes, it's a great question. Let me try to answer that. The answer is the reorder rates for this product are obviously extraordinarily strong. Without that, you wouldn't have all of these new customers that otherwise never wanted to ever use our thrombectomy products. That's being driven by the excitement that people who are using the product today and talking about it. So the 2 are linked.

是的，這是一個很好的問題。讓我嘗試回答一下。答案是該產品的再訂購率顯然非常高。如果沒有這一點，您就不會有所有這些新客戶，否則他們永遠不想使用我們的血栓切除術產品。這是由今天使用該產品並談論它的人們的興奮所推動的。所以兩者是聯繫在一起的。

There is still room -- and this is I think you all know this, having watched, been in this field for a long time. You have multiple physicians and in our particular area, you have multiple subspecialties of physicians up to 3 different ones in every hospital. So when a hospital gets the product in, it doesn't mean that in some cases, it does, but not always every single physician and all 3 sub groups are now starting to use it. So there is still room in addition to the new places coming for are significant opportunity over the next period of time to drive additional usage within the hospitals that have already been approved.

仍然有空間——我想你們都知道這一點，因為在這個領域已經觀察了很長時間。您有多名醫生，在我們的特定領域，每家醫院都有多個醫生亞專科，最多 3 個不同的醫生。因此，當醫院獲得該產品時，並不意味著在某些情況下確實如此，但並不總是每個醫生和所有 3 個亞組現在都開始使用它。因此，除了新的地方之外，在接下來的一段時間內，仍然有很大的機會來推動已批准的醫院內的更多使用。

Your next question comes from the line of Pito Chickering with Deutsche Bank.

您的下一個問題來自德意志銀行的 Pito Chickering。

Nice quarter. You quantified how much the U.S. Vascular grew some 50% year-over-year. How much of that grow sequentially from the first quarter? And then you guided to U.S. growth accelerating largely in the third quarter. Again, from a sequential perspective, how much we consider the U.S. vascular market growing from 2Q into 3Q?

不錯的季度。您量化了 U.S. Vascular 同比增長約 50% 的程度。與第一季度相比，其中環比增長了多少？然後你指導美國經濟增長在第三季度大幅加速。再次，從環比的角度來看，我們認為美國血管市場從第二季度到第三季度的增長有多大？

Yes. So we didn't quantify the sequential growth. What we said was actually, we did -- in such that we said U.S. venous in total grew sequentially strong double digits. And U.S. arterial also grew double digits. So that's the vast majority of it. We had another strong quarter in coronary as well. It didn't grow quite as fast, but on a year-over-year basis, it was double digits as well.

是的。所以我們沒有量化連續增長。我們所說的實際上是我們所做的——我們說美國的靜脈總量連續強勁地增長了兩位數。美國動脈也增長了兩位數。這就是其中的絕大多數。我們在冠狀動脈領域也經歷了另一個強勁的季度。它的增長速度沒有那麼快，但與去年同期相比，也達到了兩位數。

Okay. Great. And then on margins, [given] margins done nicely for this quarter with the strong revenue growth. Can you provide any updated guidance on how we should think about exit rate for the fourth quarter of this year?

好的。偉大的。然後是利潤率，[鑑於]本季度利潤率表現良好，收入增長強勁。您能否提供有關我們如何考慮今年第四季度退出率的最新指導？

Yes, I'll start and then maybe with respect to your latter part of your question. We, indeed, as I said in my prepared remarks, expect to be above 10% pro forma operating margins as we exit this year. And I think importantly, that is not a place we see it stopping. We see continued expansion subsequent to that in 2024 and beyond.

是的，我將開始，然後也許是關於你問題的後半部分。事實上，正如我在準備好的發言中所說，我們預計今年退出時預計營業利潤率將超過 10%。我認為重要的是，我們認為它不會就此停止。我們預計 2024 年及以後將繼續擴張。

Maggie, what would you add to that?

瑪吉，你想補充什麼？

No, I think you sum it up well. I mean, with continuing favorable mix and volume leverage and continue to scale, that's the trend we'll continue to see throughout the year.

不，我認為你總結得很好。我的意思是，隨著持續有利的組合和數量槓桿以及繼續擴大規模，這是我們全年將繼續看到的趨勢。

Your next question comes from the line of Shagun Singh with RBC Capital.

您的下一個問題來自 RBC Capital 的 Shagun Singh。

I just wanted to ask the 2024 question perhaps in a different way. I'm just trying to figure out what year 2 looks like versus year 1? You have talked about this being a multiyear launch. You've talked about at least a 5-year runway. So as we think about year 2, and it does also seem that there's a process to get the product on board. So as you think about year 2, do you expect growth to be stronger, similar or below '23? Just anything that can help us handicap the opportunity better would be helpful.

我只是想以不同的方式問 2024 年的問題。我只是想弄清楚第二年與第一年相比是什麼樣子？您曾談到這是一個多年的發布。您談到了至少 5 年的跑道。因此，當我們考慮第二年時，似乎確實有一個讓產品上線的流程。那麼，當您考慮第 2 年時，您預計增長會更強勁、與 23 年類似還是低於 23 年？任何可以幫助我們更好地阻止機會的事情都會有所幫助。

Well, first of all, thanks for the question. And as importantly, thank you for giving me the heads up that you were going to ask that question and try to frame it a different way. I'll repeat the answer.

嗯，首先，謝謝你的提問。同樣重要的是，感謝您提醒我您將提出這個問題並嘗試以不同的方式來闡述它。我會重複一下答案。

It's still summertime in 2023. So we're not going to obviously answer that in the kind of specifics. What I really want to sort of maybe summarize the comments we've made this quarter around what's ahead of us is not to sort of differentiate between what's behind us and what's ahead of us. But just to explain the level of interest deep into our subspecialties at a place in a way that we have not ever seen before in any product we've ever launched. And that's pretty exciting because it means that the products are working, they're doing work.

2023 年仍然是夏季。所以我們不會明確地回答這個具體問題。我真正想要總結的可能是我們本季度圍繞我們前面的事情所做的評論，而不是區分我們後面的事情和我們前面的事情。但只是為了解釋我們對某個地方的子專業的深入興趣程度，這是我們在推出的任何產品中從未見過的。這非常令人興奮，因為這意味著產品正在發揮作用，它們正在發揮作用。

When you go to -- for example, a vascular surgeon, who has done open surgery on the arterial side for years and years and has never wanted to even listen to our prior generations. And now is intrigued when they see both and does one case and then tells us that they're going to convert over to everything. That's not happening. That's not normal.

例如，當你去看一位血管外科醫生時，他多年來一直在動脈側進行開放手術，甚至從來不想听我們前幾代人的意見。現在，當他們看到兩者並做了一個案例，然後告訴我們他們將轉向一切時，我們很感興趣。那並沒有發生。這不正常。

And it means that there's a lot ahead of us, and that's an exciting moment for us. How do we quantify that between 2023, 2024, 2025 and going forward? It means we have a lot of work ahead. We have to do the work. We have to get in the hospitals. We have to make sure we have that. All of that is positive, and it puts us in a really good shape. So I apologize for not being able to quantify it for 2024 yet. Obviously, we will at the appropriate time. But we're in a really good spot, and we're pretty excited about it. We know we have the work to do -- but this is -- these launches are different, all 3 of them than things we've had before.

這意味著我們還有很多事情要做，這對我們來說是一個激動人心的時刻。我們如何量化 2023 年、2024 年、2025 年以及未來的情況？這意味著我們還有很多工作要做。我們必須做這項工作。我們必須去醫院。我們必須確保我們擁有這一點。所有這些都是積極的，它讓我們處於非常好的狀態。因此，我很抱歉目前還無法量化 2024 年的情況。顯然，我們會在適當的時間。但我們處於一個非常好的位置，我們對此感到非常興奮。我們知道我們還有很多工作要做，但事實是，這些發布是不同的，所有這 3 次發布都與我們之前的發布有所不同。

Got it. And then just a question on margins. I was just wondering how you're thinking about getting to beyond the plus 10%, so maybe plus 20%. And perhaps you can help us think through margin expansion this year and in the future years, do you expect it to be more linear? Or should we think about it differently? Just any directional color would be helpful.

知道了。然後只是關於利潤的問題。我只是想知道你是如何考慮超過 10% 的，所以也許是 20%。也許您可以幫助我們思考今年和未來幾年的利潤率擴張，您預計它會更加線性嗎？或者我們應該換個角度思考這個問題？任何方向性的顏色都會有幫助。

Yes, thanks for the question. So in terms of margin, I think in Jason's portion, we confirmed or continue to target 70% gross margin in a few years. So I think between '23 to '24 and beyond, we are on a pretty good pace to directionally continue to see the same expansion. And that's also translates to the operating margin trend as we continue to scale pretty well and have infrastructure in place to allow us to scale and allocate resources effectively. So I think what we have seen so far in terms of margin expansion trend, we can continue to expect that going forward in the next year.

是的，謝謝你的提問。所以就利潤率而言，我認為在傑森的部分，我們確認或繼續在幾年內實現70%毛利率的目標。因此，我認為在 23 世紀到 24 世紀及以後，我們的步伐相當不錯，可以定向繼續看到同樣的擴張。這也轉化為營業利潤率趨勢，因為我們繼續良好地擴展並擁有適當的基礎設施，使我們能夠有效地擴展和分配資源。因此，我認為到目前為止我們在利潤率擴張趨勢方面所看到的情況，我們可以繼續預期明年的情況。

Your next question is from the line of Sam Durno with BTIG.

您的下一個問題來自 BTIG 的 Sam Durno。

Can you hear me? Okay. It's actually Ryan on Sam's line. I'm at SNIS, so I was calling in on his line.

你能聽到我嗎？好的。山姆的電話裡實際上是瑞安。我在 SNIS，所以我打了他的電話。

Yes, we can hear you.

是的，我們能聽到你的聲音。

Good. So a couple of questions. I'm here listening to all the clinical sessions and it's clear you're competing for patients in these trials with Thunderbolt. And just Adam, I want to understand kind of your view on cyclic aspiration today versus maybe what it was a year ago or kind of as you embarked on this endeavor. Has it changed? Or has it not changed in terms of the opportunity in the market for cyclic aspiration relative to maybe things like large bore aspiration and kind of what you think that can do when Thunderbolt does eventually come to market?

好的。有幾個問題。我在這裡聆聽所有的臨床會議，很明顯，你們正在使用 Thunderbolt 來爭奪這些試驗中的患者。亞當，我想了解一下您今天對周期性願望的看法，與一年前或您開始這項努力時的看法相比。它改變了嗎？或者，就循環吸氣市場的機會而言，相對於大口徑吸氣之類的東西以及您認為當 Thunderbolt 最終進入市場時可以做的事情而言，它是否沒有改變？

Yes, it's a great question and an appropriate one, given that you're right in the middle of SNIS right now. Let me just -- a couple of terminologies to make sure we're all on the same page. And then I really, really want to -- because this seemed like the third or fourth question that is being asked. And I'm not sure why -- what I'm saying is not registering.

是的，這是一個很好的問題，也是一個合適的問題，因為您現在正處於 SNIS 的中心。讓我簡單介紹幾個術語，以確保我們都達成共識。然後我真的真的很想——因為這似乎是被問到的第三或第四個問題。我不知道為什麼——我所說的不是註冊。

Cyclic aspiration is something different. We don't do cyclic aspiration. That's turning a pump on and off. It means nothing. It doesn't have any real effect.

循環吸氣則有所不同。我們不進行循環抽吸。這就是打開和關閉泵。這不代表任何意思。它沒有任何實際效果。

Modulated aspiration is very different and that's what Thunderbolt does. It's also what Lightning Bolt does. And obviously, we've treated like 1,000 patients now with Lightning Bolt. And it's -- as I just said, it's extraordinary. It's amazing technology that is changing people's thoughts about treating patients after years of doing something else. So -- there cannot be any misunderstanding about my level of enthusiasm and excitement about modulated aspiration to get clot out of the body. I want that to be crystal clear.

調節吸氣非常不同，這就是 Thunderbolt 的作用。這也是閃電的作用。顯然，我們現在已經用 Lightning Bolt 治療了大約 1,000 名患者。正如我剛才所說，這是非凡的。這項令人驚嘆的技術正在改變人們在多年從事其他工作後對治療患者的想法。因此，我對調節渴望將血栓排出體外的熱情和興奮程度不能有任何誤解。我希望這一點非常清楚。

Now there's a question as neuro of Thunderbolt large bore aspirations, large bore aspiration catheters have been around for while. None of them are -- in my understanding are actually cleaner, they're either in a trial or they have a guide catheter or an indication that are being used off label. Because they're in a trial. There's a bunch of those trials going on. Those are typically guide catheter sizes where they're trying to push them up to the M1. You can ask around whether that's currently inside or not, I think the answer is fairly, obvious.

現在有一個問題，因為 Thunderbolt 大口徑抽吸的神經，大口徑抽吸導管已經存在了一段時間。在我看來，它們實際上都不是更清潔的，它們要么正在試驗中，要么有引導導管或在標籤外使用的適應症。因為他們正在接受審判。有很多這樣的試驗正在進行中。這些通常是引導導管尺寸，他們試圖將其推至 M1。你可以問問周圍是否現在在裡面，我認為答案是相當明顯的。

So let's focus on the most important thing to start a stroke case. You got to get there. You got to get there. We now have a technology that brings appropriate sized catheter up to the clot faster and easier than any other product we've ever had or anyone else has ever had. That should be something we're excited about. At the same time, we're also excited about Thunderbolt and the results of that, and we can't wait for that to come out because we already know both in the trial and obviously, with Thunder -- Lightning Bolt being used so much how it works. That's [learning] process.

因此，讓我們關注中風病例中最重要的事情。你必須到達那裡。你必須到達那裡。我們現在擁有一項技術，可以比我們或任何其他人曾經擁有的任何其他產品更快、更輕鬆地將適當尺寸的導管帶到凝塊處。這應該是我們感到興奮的事情。與此同時，我們也對 Thunderbolt 及其結果感到興奮，我們迫不及待地想知道它的結果，因為我們已經在試驗中知道了，顯然，Thunderbolt 被大量使用怎麼運行的。這就是[學習]過程。

It doesn't happen immediately. It will take a little longer for Thunderbolt. But in that time period, we don't have to wait to do what we're doing, which is taking significant share and likely growing the market at the same time. And I was just there yesterday, I apologize for missing you. But the level of enthusiasm is at an all-time high. It's back pre-pandemic levels of enthusiasm. We had meetings with physicians who are talking about going into the community and doing the work necessary to drive this. And in a large part, it's around idea that access getting to the clot with an appropriate size catheter like RED 72 with SENDit is the answer. So I want to -- there is a terrible misunderstanding if anyone thinks I'm -- what I'm saying about Thunderbolt is a negative. Thunderbolt is great. It's also nice to have something equally great that does something else which is RED 72 with SENDit.

它不會立即發生。 Thunderbolt 需要更長的時間。但在那個時期，我們不必等待就可以做我們正在做的事情，我們正在佔據重要份額，同時可能會擴大市場。我昨天才在那兒，很抱歉錯過了你。但人們的熱情空前高漲。人們的熱情又回到了大流行前的水平。我們與醫生舉行了會議，他們正在討論進入社區並開展必要的工作來推動這一目標。在很大程度上，答案是通過適當尺寸的導管（例如帶有 SENDit 的 RED 72）進入凝塊。所以我想——如果有人認為我是——我所說的有關 Thunderbolt 的內容是負面的，那就是一個可怕的誤解。迅雷太棒了能有一些同樣出色的東西來做其他事情也很高興，那就是帶有 SENDit 的 RED 72。

Crystal clear, Adam. Thank you for saying that. Last question for me. You talked about pricing and the benefit you're getting in vascular for Lightning. Or you talked about the benefit you're getting on SENDit with RED 72. Can you give us any color in terms of the pricing benefit relative to, say, a volume mix assumed in your guidance given that you are getting some premium on price for these technologies when we think about guidance for the remainder of the year?

水晶般清澈，亞當。謝謝你這麼說。對我來說最後一個問題。您談到了閃電網絡的定價以及您在血管方面獲得的好處。或者您談到了您在 SENDit 上使用 RED 72 獲得的好處。考慮到您在價格上獲得了一定的溢價，您能否給我們提供相對於您指南中假設的銷量組合的定價優勢方面的任何信息？當我們考慮今年剩餘時間的指導時，這些技術會怎樣？

Yes. It's a really, really good question, and I'm glad you asked it. I mentioned pricing really for a slightly different reason, we just have a simple system. We got a price. It's easy, everyone knows it. And we're hearing that, that is a valuable, a valuable way to conduct business. That being said, we're always -- always have been priced fairly, and that's been our reputation out there, and that stays our reputation. And I think that's important because you're in business for a long time, your reputation and how you conduct yourself and what price you charge is fair.

是的。這是一個非常非常好的問題，我很高興你提出這個問題。我提到定價的原因略有不同，我們只是有一個簡單的系統。我們得到了一個價格。這很容易，每個人都知道。我們聽說，這是一種非常有價值的開展業務的方式。話雖這麼說，我們始終——始終定價公平，這就是我們的聲譽，也將永遠保持我們的聲譽。我認為這很重要，因為你經營了很長時間，你的聲譽、你的行為方式以及你收取的價格都是公平的。

That being said, obviously, there's a small premium for our products. We talked about this for the new products. It's a little bit mitigated because like the Flash, you don't need a separator. And so the vast majority of our guidance and success in the past couple of quarters is being driven off increased usage of the products, not pure price. And the reason that's important to say that, one, it's true, but more importantly, it's sustainable. Price has a short shelf life to it. And it's not something that we've ever will take an appropriate price when necessary, but we want to grow our business with sustainable share gain and market growth, which is very different than a short-term 1-year bump full price.

話雖這麼說，顯然我們的產品有一點溢價。我們在新產品中討論了這一點。它有點緩解，因為像 Flash 一樣，您不需要分隔符。因此，過去幾個季度我們的絕大多數指導和成功都是由於產品使用量的增加而推動的，而不是純粹的價格。之所以說這一點很重要，一是這是事實，但更重要的是，它是可持續的。價格的保質期很短。我們不會在必要時採取適當的價格，但我們希望通過可持續的份額增長和市場增長來發展我們的業務，這與短期的 1 年漲價全價有很大不同。

Given the time your final question on today's call is from the line of David Rescott with Baird.

考慮到今天電話會議的最後一個問題是由 David Rescott 和 Baird 提出的。

Congrats on the strong quarter. Maybe I'll start off, Adam, on your comments around an expectation for a dominant share in the U.S. stroke space within the next 3 to 4 quarters. I guess one more basic question. Should we assume that this implies that you expect to have a majority share in the U.S. stroke market within the next 3 to 4 quarters. And I guess, given the longer time line to Thunderbolt, does this imply that SENDit is generally what is getting you to that dominant share position rather than more or less being dependent on Thunderbolt?

祝賀季度表現強勁。亞當，也許我會先談談您對未來 3 到 4 個季度內在美國中風領域佔據主導地位的預期的評論。我想還有一個基本問題。我們是否應該假設這意味著您預計將在未來 3 到 4 個季度內佔據美國中風市場的多數份額？我想，考慮到 Thunderbolt 的使用時間較長，這是否意味著 SENDit 通常是讓您獲得主導份額的原因，而不是或多或少依賴 Thunderbolt？

Yes. You want me to expand on that? Yes. The answer is, yes. SENDit, and that's what I meant by -- we don't have to wait -- when Thunderbolt comes, there'll be more fun. We'll have more growth. It will add to our benefit in the future. But we don't have to wait for that benefit now. We have -- and when we first started talking about Thunderbolt, which was a few years ago, we didn't have SENDit. So we didn't know that we would not have to wait. And the fact that we don't have to wait, and we all thought we did, and now we don't is a positive. It's really kind of exciting.

是的。你想讓我擴展一下嗎？是的。答案是，是的。發送它，這就是我的意思 - 我們不必等待 - 當 Thunderbolt 到來時，會有更多樂趣。我們會有更多的成長。這將增加我們未來的利益。但我們現在不必等待這個好處。我們有——幾年前，當我們第一次開始談論 Thunderbolt 時，我們還沒有 SENDit。所以我們不知道我們不必等待。事實上，我們不必等待，我們都以為我們已經等了，但現在我們不需要等待，這是一個積極的因素。這真的很令人興奮。

And to see, we had a tech suite at SNIS. We had physicians who were trying the products without SENDit and they were getting stuck around the curve. They then try it with SENDit and failed right up over and over again. And the reaction is like, that's amazing. And that's about patient safety. It's about getting the clot out fast because, again, if you take -- if you're using Thunderbolt to get the clot out and it takes a minute or 2, but it took you 45 minutes to get there, there's still room for improvement in that case. But if you can get there in a minute or 2, and you can get the clot out in a minute or 2, then you've really done the work. So we're doing work now to get the first part of the case, the most important, getting there. And then we'll add to that with Thunderbolt when it comes. Frankly, that feels like a pretty good set up for success for many years.

值得一提的是，我們在 SNIS 擁有一套技術套件。我們的醫生在沒有 SENDit 的情況下嘗試產品，但他們陷入了困境。然後他們嘗試使用 SENDit，但一次又一次失敗。反應就像，這太棒了。這關係到患者的安全。這是關於快速取出血栓，因為，如果你使用 Thunderbolt 取出血栓，需要一到兩分鐘，但你花了 45 分鐘才能到達那裡，仍然有改進的空間在這種情況下。但如果你能在一兩分鐘內到達那裡，並且你能在一兩分鐘內取出血栓，那麼你就真的完成了工作。因此，我們現在正在努力完成案件的第一部分，也是最重要的部分。然後我們將在 Thunderbolt 出現時添加它。坦率地說，這感覺像是為多年來的成功做好了良好的準備。

Okay. No, that's helpful. I guess my second question, just on the margin -- gross margin operating margin. Longer-term goals? And I think you said maybe the above 70% gross margins within a few years. Wondering if you'd be able to qualify that as maybe closer to the 2- to 3-year time frame or something that's within a 5-year view? And then just wondering more or less on the operating margin side, just based on your -- with the launches with kind of the sales force today, should there be any thought about accelerating or any incremental spend maybe on the sales force side in back half of this year and into 2024? Are you kind of set with where the business is today?

好的。不，這很有幫助。我想我的第二個問題，就是關於毛利率——毛利率、營業利潤率。更長期的目標？我想你說的毛利率可能會在幾年內達到70%以上。想知道您是否能夠將其限定為可能更接近 2 到 3 年的時間範圍或 5 年以內的時間範圍？然後只是想或多或少地了解營業利潤方面，只是根據今天銷售人員的發布，是否有任何關於加速或任何增量支出的想法可能在後半部分的銷售人員方面今年到 2024 年？您對目前的業務狀況滿意嗎？

Yes. No, thanks for your question. I think in terms of the gross margin, yes, I think we previously mentioned 2 to 3 years out is the right target to look at. And we'll continue to see all the favorable factors that we've been seeing both margin and both mix and volume and scalability.

是的。不，謝謝你的提問。我認為就毛利率而言，是的，我認為我們之前提到的 2 到 3 年是值得關注的正確目標。我們將繼續看到我們已經看到的所有有利因素，包括利潤、組合、數量和可擴展性。

And on the sales force side, it's a really -- it's a good question. We really -- we have an incredible team, and we cover the whole U.S. pretty effectively. We may have to add 1 person, 2 person here and there care to grow. But for the most part, we're not going to -- we're going to be able to get some real leverage there. We don't think we'll need -- this is sort of the busiest they'll be because they're launching new products. They're going through the process in all these hospitals and they're doing case coverage and as somebody raised the coil business. I think it will get over time, more normalized. And our team is amazing. I called them out in the prepared remarks for just the sheer volume of work that people have done in the first half of the year. I think we'll get a lot of leverage out of that because I do not think we need to fundamentally change the size of the team.

在銷售人員方面，這是一個非常好的問題。我們確實擁有一支令人難以置信的團隊，並且我們非常有效地覆蓋整個美國。我們可能要增加1個人，這裡那裡需要2個人來照顧成長。但在大多數情況下，我們不會——我們將能夠在那裡獲得一些真正的影響力。我們認為我們不需要——這是他們最繁忙的時候，因為他們正在推出新產品。他們正在所有這些醫院經歷這個過程，他們正在做病例報導，並且有人提出了線圈業務。我認為隨著時間的推移，它會變得更加正常化。我們的團隊很棒。我在準備好的發言中指出他們只是因為人們在今年上半年所做的大量工作。我認為我們將從中獲得很大的優勢，因為我認為我們不需要從根本上改變團隊的規模。

At this time, I will turn the call back to Ms. Hamlyn-Harris.

此時，我會將電話轉回哈姆林-哈里斯女士。

Thank you, operator. On behalf of our management team, thank you all again for joining us today and for your interest in Penumbra. We look forward to updating you on our third quarter call.

謝謝你，接線員。我謹代表我們的管理團隊，再次感謝大家今天加入我們以及對 Penumbra 的興趣。我們期待向您通報第三季度電話會議的最新情況。

Ladies and gentlemen, this concludes today's conference call. You may now disconnect.

女士們、先生們，今天的電話會議到此結束。您現在可以斷開連接。