Penumbra Inc (PEN) 2023 Q3 法說會逐字稿

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

午安.我叫 Adam，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 年第三季電話會議。 （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 the Penumbra's earnings release for the third 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. .

感謝營運商，感謝大家參加今天的電話會議，討論 Penumbra 2023 年第三季度的收益發布。新聞稿和財務表格（其中包括 GAAP 與非 GAAP 調節表）的副本可在我們公司網站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. 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.

在本次電話會議期間，本公司將根據 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表現、商業化、臨床試驗、監管狀況、品質合規性和商業趨勢。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. 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 press release.

因此，我們提醒您不要過度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 不承擔因新資訊、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聲明的義務。在本次電話會議上，某些財務指標是根據非公認的會計原則提出。我們的新聞稿中提供了相應的 GAAP 衡量標準以及 GAAP 與非 GAAP 財務衡量標準的調整表。

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 third quarter. And Jason Mills, our Executive Vice President of Strategy, will discuss our 2023 guidance. With that, I would like to turn over the call to Adam Elsesser.

Penumbra 董事長兼執行長 Adam Elsesser 將提供業務最新動態。我們的財務長 Maggie Yuen 隨後將討論我們第三季的財務表現。我們的策略執行副總裁 Jason Mills 將討論我們的 2023 年指導方針。至此，我想將電話轉給 Adam Elsesser。

Thank you, Jee. Good afternoon. Thank you for joining Penumbra's Third Quarter 2023 Conference Call. Our total revenues for the third quarter were $270.9 million, a year-over-year increase of 26.8% as reported and 25.9% on a constant currency basis. Our worldwide thrombectomy business achieved record revenue of $179.1 million, growing 38% on a year-over-year basis.

謝謝你，傑。午安.感謝您參加 Penumbra 2023 年第三季電話會議。我們第三季的總營收為 2.709 億美元，按報告年增 26.8%，以固定匯率計算成長 25.9%。我們的全球血栓切除業務收入達到創紀錄的 1.791 億美元，年增 38%。

Our worldwide embolization and other revenue was $91.9 million, increasing 9.5% over the same period a year ago. Our global vascular thrombectomy business led our growth increasing 56.9% year-over-year, while neurothrombectomy grew 10.3% year-over-year. We had another very strong quarter in the United States as revenue of $194.8 million grew 30.9% year-over-year, led by total U.S. thrombectomy, which increased to 42.1% year-over-year.

我們的全球栓塞和其他收入為 9,190 萬美元，比去年同期成長 9.5%。我們的全球血管血栓切除業務帶動我們年增 56.9%，而神經血栓切除業務較去年同期成長 10.3%。我們在美國的季度業績又表現強勁，營收為 1.948 億美元，年增 30.9%，其中美國血栓切除術總額較去年同期成長 42.1%。

Our strong growth in thrombectomy this quarter, during which we did not have new product launches as we've had in the first 2 quarters of the year shows how demand is building for our computer-assisted vacuum thrombectomy and stroke products. In fact, we expect our total thrombectomy growth, both in the United States and globally to accelerate slightly in the fourth quarter on a year-over-year basis and we expect growth in embolization and access to be similar to the third quarter.

本季我們的血栓切除術業務強勁成長，在此期間我們沒有像今年前兩個季度那樣推出新產品，這表明對我們的電腦輔助真空血栓切除術和中風產品的需求正在不斷增長。事實上，我們預計第四季度美國和全球的總血栓切除術成長將比去年同期略有加速，我們預計栓塞和取得的成長將與第三季度相似。

We expanded our gross margins in the third quarter to 65.6%. Strong revenue growth and gross margin expansion coupled with disciplined operating investments and commercial execution made the third quarter the most profitable quarter in our company's history. Non-GAAP operating income was a record $33.2 million representing [12.3%] of revenue. We posted record adjusted EBITDA of $51.5 million or 19% of total revenue compared to $14.6 million last quarter and 8.9% in the third quarter last year. We also grew our operating cash balance by $27.8 million sequentially.

第三季我們的毛利率擴大至 65.6%。強勁的收入成長和毛利率擴張，加上嚴格的營運投資和商業執行，使第三季成為我們公司歷史上利潤最高的季度。非 GAAP 營業收入達到創紀錄的 3,320 萬美元，佔營收的 [12.3%]。我們公佈的調整後 EBITDA 創歷史新高，達到 5,150 萬美元，佔總營收的 19%，而上季為 1,460 萬美元，去年第三季為 8.9%。我們的營運現金餘額也連續增加了 2,780 萬美元。

Looking forward, we expect to deliver strong revenue growth, gross margin expansion, increasing profit margins and strong cash flow in 2024, 2025 and beyond. Penumbra is the largest thrombectomy company in the world and developing proprietary technologies to take thrombus out of the body, wherever it is from head to toe has always been our mission. Almost 20 years of incremental innovative successes have led to this transformational moment in our company's history and the thrombectomy market. We have now successfully developed proprietary computer-assisted vacuum thrombectomy products that optimize the 3 most important elements of clot removal, safety, speed and simplicity. Lightning Flash and Lightning Bolt 7 and RED 72 ascended are currently driving our momentum.

展望未來，我們預計將在 2024 年、2025 年及以後實現強勁的收入成長、毛利率擴張、利潤率提高和強勁的現金流。 Penumbra 是世界上最大的血栓切除術公司，開發專有技術將血栓從體內取出，無論血栓從頭到腳在哪裡，一直是我們的使命。近 20 年的漸進創新成功導致了我們公司歷史和血栓切除市場的這一轉型時刻。我們現已成功開發出專有的電腦輔助真空血栓切除術產品，該產品優化了血栓清除的 3 個最重要的要素：安全性、速度和簡單性。 Lightning Flash、Lightning Bolt 7 和 RED 72 的提升目前正在推動我們的發展勢頭。

Because of these products, we expect to achieve an extraordinary milestone during the fourth quarter. We expect to treat more than 100,000 clot patients in the United States during 2023 alone with our thrombectomy products. We obviously still have a long way to go to help the 1,250,000 patients each year in the U.S. that have significant clot burden. But this is a notable achievement for our physician customers and our team.

由於這些產品，我們預計在第四季度實現非凡的里程碑。我們預計僅在 2023 年，美國就將使用我們的血栓切除產品治療超過 10 萬名血栓患者。顯然，要幫助美國每年 1,250,000 名患有嚴重血栓負擔的患者，我們還有很長的路要走。但這對我們的醫生客戶和我們的團隊來說是一項顯著的成就。

In vascular thrombectomy, we had a strong third quarter. Lightning Flash and Lightning Bolt 7 delivered strong growth for our U.S. arterial and venous franchises. This success was achieved with over 1,200 total customer accounts, which we define as hospitals using either flash or bolt. So in some cases, hospitals are counted twice if they are using both products. As an update on the number of pending accounts, which are in addition to those I just mentioned, we succeeded in obtaining well over 650 new VAC approvals last quarter for flash or Bolt. And these accounts are now working through the typical supply chain process prior to placing their initial orders.

在血管血栓切除術方面，我們第三季表現強勁。 Lightning Flash 和 Lightning Bolt 7 為我們的美國動脈和靜脈特許經營業務帶來了強勁成長。這項成功是透過超過 1,200 個客戶帳戶實現的，我們將這些客戶帳戶定義為使用快閃記憶體或螺栓的醫院。因此，在某些情況下，如果醫院同時使用這兩種產品，就會被計算兩次。作為待處理帳戶數量的更新（除了我剛才提到的帳戶之外），上個季度我們成功獲得了超過 650 個針對快閃記憶體或 Bolt 的新 VAC 批准。這些客戶現在在下初始訂單之前正在經歷典型的供應鏈流程。

We expect many of these customers to order and begin using flash or bolt this quarter. In addition, we currently have at least 600 additional accounts that are still working through the initial VAC process and we expect most of those accounts to order in Q1 or Q2 of 2024. Therefore, we expect the majority of our potential customer base will have flash or bolt on their shelves during the first half of 2024. Once these products are available and starting to be used our work shifts to going deeper with training and increasing the use of CAVT in cases that currently use open surgery or lytic as the primary mechanism.

我們預計許多此類客戶將在本季度訂購並開始使用閃存或螺栓。此外，我們目前還有至少 600 個其他帳戶仍在完成初始 VAC 流程，我們預計其中大多數帳戶將在 2024 年第一季或第二季訂購。因此，我們預計大多數潛在客戶群將擁有快閃記憶體或在2024 年上半年上架。一旦這些產品上市並開始使用，我們的工作就會轉向更深入的培訓，並在目前使用開放手術或溶解術作為主要機制的病例中增加CAVT 的使用。

So far, the reorder rates for both flash and Bolt are as high as any product we've ever launched in thrombectomy. In the stroke thrombectomy, we are gaining share from our already majority position. RED 72 with sended technology is still early in its adoption curve as many hospitals work through the submission process for this product as well. We currently estimate that we have over 55% share of the U.S. stroke market for aspiration catheters compared to 28 other aspiration catheters that are competing against each other in the rest of the market.

到目前為止，Flash 和 Bolt 的再訂購率與我們在血栓切除術領域推出的任何產品一樣高。在中風血栓切除術方面，我們正在從已經佔多數的地位上獲得份額。採用發送技術的 RED 72 仍處於採用曲線的早期階段，因為許多醫院也在完成該產品的提交流程。目前，我們估計我們在美國中風抽吸導管市場上佔有超過 55% 的份額，而其他市場上有 28 種抽吸導管在相互競爭。

Looking forward, we believe our new technology for both the front end of the stroke procedure, namely trackability with RED 72 SENDit coupled with our innovation for the back end of the procedure, clot extraction with Thunderbolt can drive our share to 70% plus over the next several years. The 2 questions we get asked the most by investors are. First, are we ready to meet this moment of opportunity in thrombectomy? And second, what specific work is Penumbra doing to bring CAVT to the other 90% of patients who aren't receiving thrombectomy today. The answer to the first question is, yes, I am confident that our team understands the serious work ahead and is able to meet the moment and think bigger than ever before. Now without sharing competitive information, let me outline the specific areas of work ahead. Our work is focused on 3 areas: innovation, internal readiness and implementation of market access work modeled after the historically best companies work for long-term sustainable growth.

展望未來，我們相信我們針對中風手術前端的新技術，即 RED 72 SENDit 的可追蹤性，加上我們針對手術後端的創新，利用 Thunderbolt 進行凝塊提取，可以將我們的份額提高到 70% 以上。未來幾年。投資人問我們最多的兩個問題是。首先，我們準備好迎接血栓切除術的這個機會了嗎？其次，Penumbra 正在做什麼具體工作，以便將 CAVT 帶給目前未接受血栓切除術的其他 90% 的患者。第一個問題的答案是，是的，我相信我們的團隊了解未來的嚴肅工作，並且能夠應對當下時刻並比以往任何時候都思考得更遠大。現在，在不分享競爭資訊的情況下，讓我概述一下未來工作的具體領域。我們的工作主要集中在三個領域：創新、內部準備和市場准入工作的實施，效仿歷史上最好的公司，致力於長期永續成長。

First, our innovation pipeline is robust. We are hearing from our physician customers as well as hospital systems that computer-assisted vacuum thrombectomy is the future standard for thrombectomy. Over the next 18 months, we plan to launch 4 new CAVT products in the United States. Coupled with flash and Bolt 7, we expect our CAVT portfolio will drive both market share and market growth in DVT, PE and arterial. In addition to these new products coming in the near term, we have made significant advancements with next-generation technology that could expand both the scope and dominance of our CAVT platform over the long term.

首先，我們的創新管道很強大。我們從醫生客戶和醫院系統得知，電腦輔助真空血栓切除術是血栓切除術的未來標準。未來 18 個月，我們計劃在美國推出 4 款新 CAVT 產品。與快閃記憶體和 Bolt 7 結合，我們預期 CAVT 產品組合將推動 DVT、PE 和動脈的市場份額和市場成長。除了近期推出的這些新產品外，我們還在下一代技術方面取得了重大進展，從長遠來看，這些技術可以擴大我們 CAVT 平台的範圍和主導地位。

We will talk more about these developments in the future. But for now, I will say that these technologies will be integrated into our CAVT platform and will be able to provide unique benefits to our physician customers and their hospitals, including further optimizing patient outcomes and physician use.

我們將來會更多地討論這些發展。但目前，我想說的是，這些技術將整合到我們的 CAVT 平台中，並將能夠為我們的醫生客戶及其醫院提供獨特的好處，包括進一步優化患者的治療結果和醫生的使用。

The second area is internal readiness. We have already started serious work on efficient manufacturing at scale, which includes raw material acquisition, stable supply chain and efficient capacity utilization. We have also started the work to bring even more efficiency and scale to our customer and sales field support teams, enabling faster order processing time and all time to them. And of course, we are focused on evolving our commercial team, particularly in vascular.

第二個領域是內部準備狀況。我們已經開始認真進行大規模高效製造工作，包括原料採購、穩定的供應鏈和高效的產能利用。我們也開始努力為我們的客戶和銷售現場支援團隊帶來更高的效率和規模，從而為他們提供更快的訂單處理時間和更多時間。當然，我們專注於發展我們的商業團隊，特別是在血管方面。

Currently, our team has a lot to focus on, launching 2 new transformative products in thrombectomy plus continuing to grow with our current coronary thrombectomy product and our market-leading embolization portfolio with an appropriate investment that we believe marries well with our movement to stronger profitability. We will evolve the commercial team over the next 2 quarters, putting a team in an even stronger position to take advantage of the opportunity in 2024 and beyond in thrombectomy.

目前，我們的團隊有很多需要關注的事情，推出了2 種新的血栓切除術變革性產品，並透過我們目前的冠狀動脈血栓切除術產品和市場領先的栓塞產品組合繼續發展，並進行了適當的投資，我們相信這與我們實現更強盈利能力的努力相結合。我們將在接下來的兩個季度發展商業團隊，使團隊處於更有利的地位，以利用 2024 年及以後血栓切除術的機會。

Third, we are starting to implement a strong market access program. Based on best-in-class historical programs focused on our computer-assisted vacuum thrombectomy platform. Internally, we refer to this work as the Penumbra CAVT initiative and it is being led by senior leaders across the organization, including Dr. Jim Benenati, our Chief Medical Officer; and [Dr. Ben Kaptamala], our Associate Chief Medical Officer working closely with senior leaders in the clinical specialties of interventional radiology, vascular surgery, interventional cardiology and neuro intervention. Together with leaders in our reimbursement clinical and commercial organizations and in concert with external partners. We believe this initiative will substantiate the advantages of our CAVT platform over the long term.

第三，我們開始實施強而有力的市場准入計畫。基於專注於我們的電腦輔助真空血栓切除術平台的一流歷史項目。在內部，我們將這項工作稱為 Penumbra CAVT 計劃，由整個組織的高級領導領導，包括我們的首席醫療官 Jim Benenati 博士；和[博士。 Ben Kaptamala]，我們的副首席醫療官，與介入放射學、血管外科、介入性心臟病學和神經介入臨床專業的高級領導密切合作。與我們報銷臨床和商業組織的領導者一起並與外部合作夥伴合作。我們相信，從長遠來看，這項舉措將證實我們 CAVT 平台的優勢。

With the important work we are doing in innovation, internal readiness and market access, we are well on our way to bringing computer-assisted vacuum thrombectomy to all hospitals treating patients with blood clots across every vascular bed from head to toe in the United States now and internationally as these products become available in the years to come. Indeed, in the United States where we have Lightning flash, bolt and SENDit, our thrombectomy business will comprise about 67% of our domestic revenue in 2023 and we expect this to grow to over 70% in 2024.

透過我們在創新、內部準備和市場准入方面所做的重要工作，我們正在順利地將電腦輔助真空血栓切除術引入美國所有醫院，治療從頭到腳每個血管床都有血栓的患者隨著這些產品在未來幾年上市，將在國際上取得成功。事實上，在我們擁有 Lightning flash、bolt 和 SENDit 的美國，到 2023 年，我們的血栓切除業務將占我們國內收入的 67% 左右，我們預計這一比例到 2024 年將增長到 70% 以上。

By contrast, our thrombectomy franchise outside the U.S. will represent approximately 55% of our international sales in both 2023 and 2024 and after which we expect our new CAVT portfolio products will influence our international growth as it is in the U.S. today. Our growth potential over the next several years is significant with our commercial focus on thrombectomy globally, plus where there are opportunities for profitable growth and embolization and access. And we are in the early stages of strong operating leverage while we still make the important investments focused on these 3 areas. The road ahead won't be a straight line nor will it be free of challenges, but if we continue to do the right things, think bigger and work purposely. We can help many more patients while stewarding a growing profitable business over the next several years. I'll now turn the call over to Maggie to go over our financial results for the third quarter.

相較之下，我們在美國以外的血栓切除特許經營權將在2023 年和2024 年占我們國際銷售額的約55%，之後我們預計我們的新CAVT 產品組合將像今天在美國一樣影響我們的國際成長。我們未來幾年的成長潛力巨大，因為我們的商業重點是全球血栓切除術，以及有獲利成長和栓塞和獲取機會的領域。我們正處於強大營運槓桿的早期階段，同時我們仍將重要投資集中在這三個領域。前進的道路不會是一條直線，也不會充滿挑戰，但如果我們繼續做正確的事情，想得更大，有目的地工作。我們可以幫助更多的患者，同時在未來幾年管理不斷成長的獲利業務。現在我將把電話轉給瑪吉，讓她檢查我們第三季的財務表現。

Thank you, Adam. Good afternoon, everyone. Today, I will discuss the financial results for the third quarter of 2023. Financial results on this call for revenue and gross margin on a GAAP basis while operating expenses and operating income 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 年第三季的財務業績。該財務業績要求收入和毛利率基於 GAAP 基礎，而營運費用和營運收入基於非 GAAP 基礎。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 財務衡量標準的調整表。

For the third quarter ended September 30, 2023, our total revenues were $270.9 million, an increase of 26.8% reported and 25.9% in constant currency compared to the third quarter of 2022. Our geographic mix of sales in the quarter was 71.9% U.S. and 28.1% international. U.S. reported growth of 30.9%, and our international regions increased 17.4% reported and 14.3% in constant currency. The sequential growth of 3.6% was primarily driven by an increase in our global thrombectomy business of $16.6 million or 10.2%, offset by a decline in our embolization and other businesses of $7.1 million or 7.2%, primarily driven by EMEA seasonality, timing of immersive healthcare milestones and our distributor customers mix.

截至2023 年9 月30 日的第三季度，我們的總營收為2.709 億美元，與2022 年第三季相比，報告成長26.8%，以固定匯率計算成長25.9%。本季我們的銷售地域組合為71.9% 美國和28.1% 國際化。美國報告成長 30.9%，國際地區報告成長 17.4%，以固定匯率計算成長 14.3%。環比增長3.6% 主要是由於我們的全球血栓切除業務增長了1,660 萬美元（即10.2%），但被我們的栓塞和其他業務下降了710 萬美元（即7.2%）所抵消，這主要是由歐洲、中東和非洲地區的季節性、沉浸式體驗的時機所推動的醫療保健里程碑和我們的經銷商客戶組合。

Moving to revenue by franchise. Revenue from our vascular business grew to $171.4 million in the third quarter of 2023, an increase of 38.9% reported and 38.5% in constant currency compared to the same period last year, driven by 50.2% year-over-year increase in U.S. vascular thrombectomy. Revenue from our neuro business was $99.5 million in the third quarter of 2023, an increase of 10.2% reported and 8.5% in constant currency compared to the same period a year ago, driven by strong performances in Europe and U.S..

轉向特許經營收入。 2023 年第三季度，我們的血管業務收入增長至 1.714 億美元，與去年同期相比，報告增長 38.9%，按固定匯率計算增長 38.5%，這主要得益於美國血管血栓切除術同比增長 50.2% 。受歐洲和美國強勁表現的推動，2023 年第三季我們的神經業務收入為 9,950 萬美元，與去年同期相比增長 10.2%，按固定匯率計算增長 8.5%。

Turning to gross margin. Gross margin for the third quarter of 2023 is 65.6%, compared to 63.3% for the third quarter of 2022 and 63.8% last quarter. The sequential improvement is driven by higher thrombectomy product mix, improvement in labor efficiencies and a stabilized supply chain environment. Our operations team continue to execute to support the demand while focusing on these production initiatives that will result in future production efficiencies. While we will accelerate our productivity and scalability investment in the next few quarters, we expect these investment costs will be offset by product mix and continued productivity improvement in the near term, which will enable further margin expansion in 2024 compared to 2023 overall.

轉向毛利率。 2023 年第三季毛利率為 65.6%，而 2022 年第三季毛利率為 63.3%，上一季毛利率為 63.8%。血栓切除產品組合的提高、勞動效率的提高和穩定的供應鏈環境推動了連續的改善。我們的營運團隊繼續執行以支援需求，同時專注於這些將提高未來生產效率的生產計劃。雖然我們將在未來幾季加快生產力和可擴展性投資，但我們預計這些投資成本將被產品組合和近期生產力的持續提高所抵消，這將使 2024 年的利潤率比 2023 年整體進一步擴大。

Now on to our non-GAAP operating expenses, which excludes a onetime expense associated with the acquisition of IPR&D of $18.2 million for this quarter. and the amortization of acquired intangible assets of $2.4 million for this quarter, the same quarter last year and last quarter. Total operating expense for the quarter was $144.5 million or 53.3% of revenue compared to $127.5 million or 59.7% of revenue for the same quarter last year and $146.6 million or 56.1% of revenue from last quarter.

現在來談談我們的非 GAAP 營運費用，其中不包括本季與收購 IPR&D 相關的一次性費用 1,820 萬美元。本季、去年同季和上季收購的無形資產攤銷為 240 萬美元。本季總營運費用為 1.445 億美元，佔營收的 53.3%，去年同期為 1.275 億美元，佔營收的 59.7%，上季營運費用為 1.466 億美元，佔營收的 56.1%。

Our research and development expenses for Q3 2023 were $21 million compared to $21.3 million from Q3 2022 and $21.5 million from last quarter. SG&A expenses for Q3 2023 were $123.5 million or 45.6% of revenue compared to $106.2 million or 49.7% of revenue for Q3 2022 and $125.1 million or 47.8% of revenue last quarter. We recorded operating income of $33.2 million or 12.3% of revenue in the third quarter of 2023, compared to an operating income of $7.8 million or 3.7% of revenue for the same period last year and operating income of $20 million or 7.8% of revenue last quarter.

我們 2023 年第三季的研發費用為 2,100 萬美元，而 2022 年第三季為 2,130 萬美元，上季為 2,150 萬美元。 2023 年第三季的銷售、管理及行政費用為1.235 億美元，佔營收的45.6%，而2022 年第三季為1.062 億美元，佔營收的49.7%，上一季為1.251 億美元，佔收入的47.8%。 We recorded operating income of $33.2 million or 12.3% of revenue in the third quarter of 2023, compared to an operating income of $7.8 million or 3.7% of revenue for the same period last year and operating income of $20 million or 7.8% of revenue last四分之一.

We continue to invest to support volume growth and long-term projects that allow us to continue to scale the organization into the future while creating a balance on disciplined spend in the present. We believe it is worthwhile to highlight our adjusted EBITDA, which excludes a onetime expense associated with the acquisition of IPR&D of $18.2 million and stock compensation of $14.1 million, $12.8 million and $9.7 million for this quarter, last quarter and the same period last year, respectively.

我們繼續投資以支持銷售成長和長期項目，使我們能夠繼續擴大組織規模以適應未來，同時在當前的嚴格支出上取得平衡。我們認為值得強調的是我們調整後的EBITDA，其中不包括與收購IPR&D 相關的一次性費用1820 萬美元，以及本季、上季和去年同期的1,410 萬美元、1,280 萬美元和970 萬美元的股票補償，分別。

We posted record adjusted EBITDA of $51.5 million or 19% of total revenue compared to 14.6% last quarter and 8.9% in the third quarter last year. Turning to our cash flow and balance sheet. We ended the third quarter with a cash, cash equivalents and marketable security balance of $248.9 million and no debt, which is an increase of $27.8 million from the last quarter. The sequential increase in cash is driven by an increase in profitability and improvements in working capital turns. And now I would like to turn the call over to Jason to discuss our guidance.

我們公佈的調整後 EBITDA 創歷史新高，達到 5,150 萬美元，佔總營收的 19%，而上季為 14.6%，去年第三季為 8.9%。轉向我們的現金流和資產負債表。第三季末，我們的現金、現金等價物和有價證券餘額為 2.489 億美元，沒有債務，比上季增加了 2,780 萬美元。現金的連續成長是由獲利能力的提高和營運資金周轉率的改善所推動的。現在我想將電話轉給傑森，討論我們的指導。

Thank you, Maggie, and good afternoon, everyone. For the fourth quarter of 2023, we expect total company revenue growth to accelerate to 28% to 31% year-over-year, which correlates to the midpoint of our annual guidance range of $1.050 billion to $1.070 billion for full year 2023. We expect global thrombectomy revenue growth to accelerate sequentially from the third quarter and expect our geographic mix of sales between the United States and international markets to be similar to the third quarter levels. I will now turn the call back to Adam for closing remarks.

謝謝瑪吉，大家下午好。對於 2023 年第四季度，我們預計公司總收入同比增長將加速至 28% 至 31%，這與我們 2023 年全年 10.5 億美元至 10.7 億美元的年度指導範圍的中點相關。我們預計全球血栓切除術收入成長將從第三季開始連續加速，預計我們在美國和國際市場之間的銷售地理組合將與第三季的水平相似。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. As CAVT becomes recognized as the future of thrombectomy, our team appreciates the serious and important work ahead. I outlined the initial phase of that work during my earlier remarks. With this opportunity in front of us, we are all in as we proudly accept the challenge to meaningfully change the number of people who benefit from our innovative technology. Thank you. And thank you, operator. We can now open the call to questions. .

謝謝傑森、瑪吉和吉。隨著 CAVT 被公認為血栓切除術的未來，我們的團隊對未來嚴肅而重要的工作表示讚賞。我在之前的演講中概述了這項工作的初始階段。有了這個機會，我們全力以赴，自豪地接受這項挑戰，以有意義地改變從我們的創新技術中受益的人數。謝謝。謝謝你，接線生。我們現在可以開始提問。 。

(Operator Instructions) And your first question comes from Robbie Marcus with JPMorgan.

（操作員說明）您的第一個問題來自摩根大通的羅比·馬庫斯。

This is actually Lilly, I'm on for Robbie. Two quick ones, I'll ask them together. Why not raise the guide by at least to be (inaudible). Is that just conservatism? Or are there other dynamics we should be keeping in mind for the rest of the year? And related to that, reiterating the guide implies a softer fourth quarter than what the street was thinking. So what's the driver of that? And how should we be thinking about the fourth quarter?

這其實是莉莉，我是羅比。兩個快點，我一起去問。為什麼不將指南至少提高到（聽不清楚）。這只是保守主義嗎？或者在今年剩下的時間裡我們還應該牢記其他動態嗎？與此相關的是，重申該指南意味著第四季的情況比華爾街的預期更為疲軟。那麼其驅動因素是什麼呢？我們該如何看待第四季？

Yes. Thank you for the question. I'll take that. This is Jason and then Adam can jump in if he likes. First, I would say the expectation that our business will accelerate to the fastest pace of the year, 28% to 31% year-over-year growth is really a positive reflection of the momentum we have right now. This guidance takes into account many things, the progress and timing with the new customers getting approvals and placing their first orders, timing of the new products and market development initiatives. But let me give you just a little bit more context on our guidance. Our thrombectomy business worldwide, as you saw, grew 38% in the third quarter. .

是的。感謝你的提問。我會接受的。這是傑森，如果亞當願意的話也可以加入。首先，我想說的是，預計我們的業務將加速到今年最快的速度，同比增長 28% 至 31%，這確實是我們目前勢頭的積極反映。該指南考慮了許多因素，包括新客戶獲得批准和下第一批訂單的進度和時間表、新產品的時間表以及市場開發計劃。但讓我為您提供有關我們指導的更多背景資訊。如您所見，我們的全球血栓切除業務第三季成長了 38%。 。

Our guidance anticipates global thrombectomy to accelerate to 40%-plus growth in the fourth quarter. It also anticipates our U.S. thrombectomy business will grow even faster than this in the high 40% range. That said, while our embolization and access businesses are market-leading franchises, they are in more established markets. So we expect growth here will be in the high single digits, which is similar to the third quarter. As we move forward, more and more emphasis, as you can probably hear across the organization will be on thrombectomy, where markets are underpenetrated and where we have a platform technology with CAVT that we believe will be the future standard. So overall, we're excited about where we're going.

我們的指導預計第四季度全球血栓切除術將加速成長 40% 以上。它還預計我們的美國血栓切除業務的成長速度將超過 40%。也就是說，雖然我們的栓塞和通路業務是市場領先的特許經營業務，但它們位於更成熟的市場。因此，我們預計這裡的成長將是高個位數，這與第三季類似。隨著我們的前進，正如您可能在整個組織中聽到的那樣，越來越多的重點將放在血栓切除術上，其中市場滲透率較低，而我們擁有CAVT 平台技術，我們相信這將成為未來的標準。總的來說，我們對我們的目標感到興奮。

The next question comes from the line of Larry Biegelsen with Wells Fargo.

下一個問題來自拉里·比格爾森 (Larry Biegelsen) 與富國銀行 (Wells Fargo) 的對話。

It's Lei calling in for Larry. One for Adam. Adam, recently talked about 20% sales growth outlook for 2024. Can you just comment on your confidence on that outlook? And what are the key drivers on the back of your strong Q3 report? And if I may have a follow-up on that, you previously expected to exit this year with mid-60% gross margin, low double-digit operating margin. You obviously already got there in Q3. So if you can comment on how to think about that exiting the year and into 2024.

是雷打來拉里的電話。一張是給亞當的。 Adam 最近談到了 2024 年 20% 的銷售成長前景。您能談談您對這一前景的信心嗎？你們強勁的第三季報告背後的關鍵驅動因素是什麼？如果我可以對此進行跟進的話，您預計今年將以 60% 左右的毛利率和較低的兩位數營業利潤率退出。顯然你已經在第三季達到目標了。那麼您是否可以評論一下如何看待這一年和 2024 年的情況。

Yes. Thank you, Lei. Let me start with the '24 guidance. We are very confident in what I said actually at your conference as at least 20%. Our plan is to give formal guidance on our fourth quarter call, which is our typical pattern. And at that point, we can give the nuance around that specific guidance. But obviously, if you hear what we're saying about the business and how it's setting up, we're obviously very confident in that at least 20% number. As it relates to the profitability margin, I will comment briefly, and then Maggie can comment more specifically. It is really important for us to run a profitable business and to increase that profitability that has been something we've prided ourselves in a long time. And now more than ever, I think the world is agreeing with that.

是的。謝謝你，雷。讓我從 '24 指南開始。我們對我在你們會議上實際所說的至少 20% 非常有信心。我們的計劃是對第四季度的電話會議提供正式指導，這是我們的典型模式。到那時，我們就可以給出具體指導的細微差別。但顯然，如果您聽過我們對業務的介紹以及業務的建立方式，我們顯然對至少 20% 的數字非常有信心。由於涉及利潤率，我將簡要評論，然後 Maggie 可以更具體地評論。對我們來說，經營獲利業務並提高獲利能力非常重要，這是我們長期以來引以為傲的事情。我認為現在世界比以往任何時候都更同意這一點。

The profitability is a very important measure. You heard it in the prepared remarks, we're setting ourselves up to run this to be more and more profitable. But Maggie can be more specific.

獲利能力是一個非常重要的衡量標準。你在準備好的發言中聽到了，我們正在努力讓這個計畫變得越來越有利可圖。但瑪姬可以說得更具體。

Yes. I feel really good about our profitability trends. I think more important to note is we are reaching a sustainable level of profitability, both in gross margin and overall operating margin. We will continue to invest in investment in a number of initiatives. But as you mentioned earlier, with the trend of increasing thrombectomy product mix, we continue to scale and leverage the overhead. We expect to continue to see gross margin and overall margin expansion moving forward for next quarter and in the longer term.

是的。我對我們的獲利趨勢感到非常滿意。我認為更重要的是，我們正在達到可持續的獲利水平，無論是毛利率還是整體營業利潤率。我們將繼續在多項措施上進行投資。但正如您之前提到的，隨著血栓切除術產品組合不斷增加的趨勢，我們繼續擴大規模並利用管理費用。我們預計下季和長期內毛利率和整體利潤率將持續成長。

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

你的下一個問題來自威廉布萊爾的瑪格麗特凱撒。

This is Malgorzata on for Margaret. So kind of another one in terms of the Q4 guidance. Obviously, you mentioned that 30% plus heading into the quarter and the 28% to 31% guidance today. So -- just wondering if anything has changed or maybe that implies any rate of seasonality. And then just what that assumes in terms of the rate of VAC approvals in Q4 relative to last quarter?

這是瑪格麗特的馬爾戈札塔。就第四季的指導而言，這是另一種情況。顯然，您提到了進入本季的 30% 以上以及今天的 28% 至 31% 指引。所以——只是想知道是否發生了任何變化，或者這可能意味著季節性的變化。那麼第四季 VAC 批准率相對於上一季的假設情況如何呢？

Yes. Well, thank you for the question. Nothing has changed. As you can hear, at the beginning of the year, we talked about our guidance being $1 billion. So it's come up quite a bit through the year. And -- last quarter, we gave an accurate assessment of how we thought the second half of the year was going to play out, and nothing has changed from that. If anything, I think you've seen the growth and we started to talk a little bit more, I think give you a little bit more specifics around our business from a thrombectomy versus embolization perspective, which gives you a sense, I think, the strength is coming perhaps even more from the thrombectomy business globally. And then obviously, in the United States, it's even stronger. So if anything, I think that's the change in disclosure that shows the strength in the business and the momentum.

是的。嗯，謝謝你的提問。什麼也沒有變。正如您所聽到的，今年年初，我們談到了我們的指導方針是 10 億美元。所以這一年它出現了很多。上個季度，我們對下半年的情況進行了準確的評估，並且沒有任何改變。如果有的話，我認為您已經看到了增長，我們開始談論更多一點，我想從血栓切除術與栓塞的角度給您更多有關我們業務的細節，我認為這讓您有一種感覺全球血栓切除術業務的力量或許更大。顯然，在美國，它甚至更強大。因此，我認為，如果有的話，那就是披露的變化顯示了業務的實力和勢頭。

Awesome. Very helpful. And then just as a follow-up in terms of the progress on the THUNDER trial. So I know I mentioned last quarter kind of the requirement to change the safety endpoint there and adding approximately 75 more patients. Noticed that there were a bit more patients added to the clinical trials website. So just wondering if there were any additional modifications to the trial design there or -- just maybe if you could speak to Thunder Bolts performance on some of the patients enrolled thus far.

驚人的。很有幫助。然後作為 THUNDER 試驗進展的後續行動。所以我知道我在上個季度提到了更改安全終點並增加大約 75 名患者的要求。注意到臨床試驗網站上增加了更多的患者。因此，我只是想知道試驗設計是否有任何額外的修改，或者 - 也許您可以談談 Thunder Bolts 在迄今為止登記的一些患者身上的表現。

Yes. No, it's a great question, and thank you for this. So the trial number that we're generally in the same ballpark that I was talking to. It's now 275 patients if I'm not mistaken. And we updated clinicaltrials.gov with the timing, which is generally consistent with what I had expected. The most -- and we'll just -- we're on that trial. We're seeing some nice enrollment right now. We're pretty excited about what we're seeing.

是的。不，這是一個很好的問題，謝謝你。因此，我們的試用數字通常與我所說的大致相同。如果我沒記錯的話，現在有 275 名患者。我們更新了 ClinicalTrials.gov 的時間安排，這與我的預期基本一致。最——我們只是——我們正在接受審判。我們現在看到一些不錯的註冊情況。我們對所看到的感到非常興奮。

I will tell you that -- the most important thing is we're very happy with the performance of the product, and that is obviously the best part of it. But we also have validation separate from that product, as you know. We have lightning bolt, and we have done a huge number of cases with that similar technology, different catheter side. And it is -- as everyone checks now, performing incredibly well. So again, we can't wait to bring that to the market, but we have to run the trial and we can only do so much to speed up the enrollment, but so far so good.

我會告訴你——最重要的是我們對產品的性能非常滿意，這顯然是它最好的部分。但如您所知，我們也有與該產品分開的驗證。我們有閃電，我們已經用類似的技術、不同的導管側完成了大量的病例。正如每個人現在所檢查的那樣，它的表現非常好。再說一次，我們迫不及待地將其推向市場，但我們必須進行試驗，我們只能做這麼多來加快註冊速度，但到目前為止還不錯。

And as we've said, we're going to be bringing this technology, the CAVT technology to every part of the body head to toe, so that we can modernize the thrombus removal and really to start taking a huge dent out of the number of patients that are suffering. And so Thunderbolt is going to be a big part of that, and our optimism is as strong as ever.

正如我們所說，我們將把這項技術，即 CAVT 技術帶到身體從頭到腳的每個部位，這樣我們就可以實現血栓清除的現代化，並真正開始大幅減少血栓數量正在遭受痛苦的患者。因此，Thunderbolt 將成為其中的重要組成部分，我們的樂觀情緒一如既往。

Your next question comes from the line of Bill Plovanic.

你的下一個問題來自比爾普洛瓦尼克（Bill Plovanic）。

First up is just, Maggie, can you help me understand, so phenomenal quarter on the operating margin at 12.3%. How should we think about Q4. It sounds like that's going to continue to go up in Q4 and sequentially as we go into 2024. And then secondly, I don't know if this, especially with your gross margin going up, but you also mentioned just on the sales force changes. I forget how you phrased it, but basically, you're going to make some changes. I wonder if you could give us some granularity on kind of what you're doing. And is that new different sales force for different indications? Is that splitting territories? Just anything you're willing to share to help us out on that.

首先，Maggie，你能幫我理解一下，這個季度的營業利潤率達到了 12.3%，非常驚人。我們應該如何看待第四季。聽起來這將在第四季度繼續上升，並在進入 2024 年時依次上升。其次，我不知道這是否會上升，特別是隨著您的毛利率上升，但您也提到了銷售人員的變化。我忘記了你是如何表達的，但基本上，你會做出一些改變。我想知道您是否可以向我們介紹一下您正在做的事情。新的不同銷售團隊是否針對不同的適應症？這是分裂領土嗎？您願意分享的任何內容都可以幫助我們解決這個問題。

Okay. Thanks, Bill. Maybe I'll touch on the margin first, and then Adam can talk about -- address the sales force. I think overall, as I mentioned earlier, the gross margin trend that we see already a few quarter sequential improvement is primarily driven by continued thrombectomy product mix, and we definitely see that trend to continue. I also mentioned overall, with continued leveraging our overall capacity. I think this is also the time that we may accelerate some of the investment in our manufacturing area. So gross margins definitely are reaching a stabilized level, but then we will continue to see more margin improvement in 2024.

好的。謝謝，比爾。也許我會先談談利潤，然後亞當可以談談——向銷售人員講話。我認為總體而言，正如我之前提到的，我們已經看到幾個季度連續改善的毛利率趨勢主要是由持續的血栓切除產品組合推動的，而且我們肯定會看到這種趨勢將繼續下去。我還提到了總體上，繼續發揮我們的整體能力。我認為這也是我們可能會加快對我們的製造領域的一些投資的時候。因此，毛利率肯定會達到穩定水平，但我們將在 2024 年繼續看到利潤率進一步提高。

In terms of OpEx leverage and overall operating margin, we continue to leverage a lot of the overhead and infrastructure investment that we put in a couple of years ago, and I think we'll continue to see more leverage going forward.

就營運支出槓桿和整體營運利潤率而言，我們繼續利用幾年前投入的大量管理費用和基礎設施投資，我認為未來我們將繼續看到更多的槓桿。

And Bill, this is Adam. To follow up on the specific sales force question. I want to thank you. I think you all might know, I love talking about our amazing sales team and what they've been able to accomplish. It's one of my favorite topics. As I laid out on the call, our team in the field, particularly in Vascular now have so much to do with our embolization business, which is the majority coil business in the market, together with launching 2 transformative products together with continuing to get cataracts or coronary thrombectomy throughout there on this still on the basis of the Storm-PE study a few years ago.

比爾，這是亞當。跟進具體的銷售人員問題。我想謝謝你。我想你們可能都知道，我喜歡談論我們出色的銷售團隊以及他們所取得的成就。這是我最喜歡的話題之一。正如我在電話會議上所說，我們的現場團隊，特別是血管領域的團隊，現在與我們的栓塞業務（市場上的大部分線圈業務）密切相關，同時還推出了2 種變革性產品，並繼續治療白內障或冠狀動脈血栓切除術仍基於幾年前的 Storm-PE 研究。

So they're just busy. And now we're facing more than like doubling the number of customers we've typically had on our thrombectomy business and getting to all that process. So the point is we are going to evolve that sales force. We are not splitting the sales force. That's not our plan. We are going to evolve it with people who can make some of this work more efficient without fundamentally changing the core structure of the sales team.

所以他們只是很忙。現在，我們的血栓切除術業務的客戶數量通常會增加一倍以上，並且需要完成所有流程。所以重點是我們要發展銷售團隊。我們不會分割銷售隊伍。那不是我們的計劃。我們將與那些能夠在不從根本上改變銷售團隊核心結構的情況下提高部分工作效率的人員一起發展它。

So I'm not going to be too much more specific for competitive reasons. As you know, I don't typically share the number of sales reps and how we think about that because that's not how we've managed our team, and our team has performed so well over the last many, many years. But we can do that within the context of our growing profitability. And that's the most important part. This isn't going to change that trajectory. And I think it will be a significant evolution of the team. but one that will allow us to do more but not impact that important part of profitability.

因此，出於競爭原因，我不會說得太具體。如您所知，我通常不會分享銷售代表的數量以及我們對此的看法，因為這不是我們管理團隊的方式，而且我們的團隊在過去很多很多年中表現得非常好。但我們可以在獲利能力不斷增長的背景下做到這一點。這是最重要的部分。這不會改變這一軌跡。我認為這將是團隊的重大演變。但這將使我們能夠做更多事情，但不會影響獲利能力的這一重要部分。

Your next question comes from the line of Michael Sarcone with Jefferies.

你的下一個問題來自 Michael Sarcone 和 Jefferies 的對話。

First one to start. You had mentioned over the next 18 months, you plan to launch 4 new CAVT product in the U.S.. I was wondering if you can give us any color there whatsoever. Are those new TAMs, new indications? Would just love to get some more color there.

第一個開始。您曾提到，在接下來的 18 個月內，您計劃在美國推出 4 款新的 CAVT 產品。我想知道您是否可以給我們任何顏色。這些是新的 TAM、新的適應症嗎？只是想在那裡得到更多的顏色。

Yes. So it's a great question. I'm very hesitant for obviously competitive reasons to give too many specifics. Needless to say, I will say the following though, and that is this is the beginning, not the end of what we think we can offer with our CAVT platform. Those 4 products are going to be significant. They're not tangential or on the sidelines.

是的。所以這是一個很好的問題。出於明顯的競爭原因，我非常猶豫是否要提供太多細節。不用說，我要說的是，這只是我們認為可以透過 CAVT 平台提供的服務的開始，而不是結束。這 4 種產品將非常重要。他們並不切線或旁觀。

And that's not the end of it. We alluded to technology that is in development that would be part of and attached to and be integrated into the whole platform, that will continue to move this field forward and making these procedures easier, making both the physicians and the hospitals feel much better about the flow and the treatment of these patients.

這還沒結束。我們提到正在開發的技術將成為整個平台的一部分、附屬於並整合到整個平台中，這將繼續推動這一領域的發展，並使這些程序變得更加容易，使醫生和醫院都對這個平台感覺更好。這些患者的流動和治療。

So we're really at the beginning of this next phase, and we'll give you more update, obviously, as those products get cleared, but again, pretty excited about what the next month -- next year looks like. And I guess our R&D team is -- it's just evolving. They've always been amazing. They've brought us this far, but they are extraordinary, and I need to do a quick shot out to them for getting us to this stage.

因此，我們確實正處於下一階段的開始，顯然，隨著這些產品的清除，我們將為您提供更多更新，但同樣，我們對下個月、明年的情況感到非常興奮。我想我們的研發團隊正在不斷發展。他們一直都很棒。他們已經讓我們走到了這一步，但他們非常出色，我需要快速向他們報告一下，他們讓我們走到了這個階段。

Great. Thank you. I believe you also disclosed, I think you said 50% U.S. vascular thrombectomy sales growth year-over-year. Can you just talk about any kind of competitive response you're seeing and then maybe what was the similar category growth international your thrombectomy business on the vascular side.

偉大的。謝謝。我相信你也透露了，我想你說美國血管血栓切除術銷售額年增50%。您能否談談您所看到的任何類型的競爭反應，然後也許您的血栓切除業務在血管方面的國際類似類別增長是什麼。

Yes, I'll start. Clearly, 50% U.S. growth in thrombectomy is multiples faster than we've seen from anywhere else. Internationally is a much smaller base, so the growth percentages can be higher quarter-to-quarter. And it was slightly higher than that this quarter, but it is because of distributor variance, you had a good quarter marginally so, and it's a smaller number, so the percentages are bigger. But both regions did well.

是的，我要開始了。顯然，美國血栓切除術增加了 50%，比我們在其他任何地方看到的成長速度要快好幾倍。國際上的基數要小得多，因此季度與季度之間的成長率可能會更高。它比本季略高，但這是由於分銷商差異，您的季度表現稍好，數字較小，因此百分比較大。但這兩個地區都表現良好。

Your next question comes from the line of Richard Newitter.

你的下一個問題來自理查德·紐特（Richard Newitter）。

I think, Adam, you had made a comment about where you are exiting the year with those -- with 1,000 VAC committees working their way through the process and you expect to be through the mall in the first half '24. I guess can you flesh that out a little bit about what exactly that means? Is there any kind of quantification or directional color we should be thinking about in terms of growth first half, second half, next year. Just I'm trying to understand, you're pretty thoughtful about those kinds of comments. So I'm just making sure we're hearing the messaging correctly around that.

我想，Adam，你已經對今年的退出發表了評論——1,000 個 VAC 委員會正在努力完成這一過程，你預計將在 24 年上半年完成整個購物中心。我想你能具體說明一下這到底是什麼意思嗎？在上半年、下半年和明年的成長方面，我們是否應該考慮某種量化或方向性的色彩？我只是想理解，你對這些評論非常有想法。所以我只是確保我們正確地聽到了相關的訊息。

Yes. No, I think it's really appropriate and great question. There's -- let me maybe sort of walk through a little bit about what I did, but also sort of the what does it mean more specifically. So we -- what I said is that there's over 650 of those centers got back approval this past quarter, but not -- have not yet ordered because they're going through what we -- for lack of a better term, we're calling the typical supply chain process where you work with the supply chain in the hospital to get the product ordered and on the shelf and all that. .

是的。不，我認為這是一個非常合適且很好的問題。讓我稍微介紹一下我所做的事情，以及它更具體的意義。因此，我們 - 我所說的是，上個季度有超過 650 個中心獲得了批准，但尚未訂購，因為他們正在經歷我們 - 由於缺乏更好的術語，我們正在調用典型的供應鏈流程，在該流程中，您與醫院的供應鏈合作，將產品訂購並上架等等。 。

And so that's going to happen for the most part, most of those during this quarter. Some might drag a touch, but most will happen this quarter. So once you get it ordered, now we don't do large stocking orders, some companies have done that over the years, we do very basic, you order 1, maybe 2 and get started. And then with that, you have success and reorder the product. So we make it pretty straightforward. So it's not a question of stocking order revenue, it's really getting going.

因此，這將在很大程度上發生，其中大部分發生在本季。有些可能會拖後腿，但大多數將在本季發生。因此，一旦您收到訂單，現在我們不做大量庫存訂單，有些公司多年來已經這樣做了，我們做的非常基本，您訂購 1 個，也許 2 個，然後開始。然後，您就成功了並重新訂購了產品。所以我們讓它變得非常簡單。所以這不是庫存訂單收入的問題，而是真正開始運作的問題。

What I also said, there are 2 other points. One is there's another 600 -- over 600 hospitals that are still in the beginning of that VAC process that haven't yet had that VAC approval. Once that happens, then they move to that second category that we have to get through the supply chain part and get on to the shelf. Once we're there, once we're ordered and able to be used, then our efforts switches in those hospitals to not only having it be used sort of the cases that are obvious.

我還說了，還有兩點。其中之一是還有另外 600 家——超過 600 家醫院仍處於 VAC 流程的開始階段，尚未獲得 VAC 批准。一旦發生這種情況，它們就會轉移到我們必須通過供應鏈部分並上架的第二類。一旦我們到達那裡，一旦我們被訂購並能夠使用，那麼我們的努力就會在這些醫院中轉變為不僅在明顯的病例中使用它。

But if you look at -- and we track this billing data at every hospital pretty carefully, how many patients are being treated with mechanical thrombectomy versus how many are still being treated with lytic open surgery depending on the vascular bed.

但如果你看一下——我們非常仔細地追蹤每家醫院的計費數據，有多少患者正在接受機械血栓切除術治療，有多少患者仍在接受溶解性開放性手術治療，具體取決於血管床。

And that's where the work really starts and that's what I was talking about that we're geared up to do that work, not only on the sales team side, but also through our market access work. So that we can bring this technology deeper into the hospital. And so once you get approved, we don't expect you to be at the normalized run rate of using our product right away. We think that will continue to grow for a while. And that's what I was articulating.

這就是工作真正開始的地方，這就是我所說的，我們準備好開展這項工作，不僅在銷售團隊方面，而且還透過我們的市場准入工作。這樣我們就可以把這項技術更深入地引入醫院。因此，一旦您獲得批准，我們並不期望您立即達到使用我們產品的正常運作率。我們認為這一數字將持續成長一段時間。這就是我所闡述的。

So this is -- this is a journey. This is a process. Again, not to diminish the success we've had this quarter, we expect to have next quarter or in '24, we're going to have a lot of success and a lot of growth, we're just going to see the work continue to build sort of year-over-year for quite a while. I guess the best way to say it is as we look at the space that thrombus in people's bodies, whether it's in the head, all the way through the body or in the toe, we are going to continue to be committed to this space. We are -- this is our focus.

所以這是——這是一趟旅程。這是一個過程。再說一遍，不要削弱我們本季度取得的成功，我們預計下個季度或 24 年，我們將取得很大的成功和很大的增長，我們只是要看到工作在相當長的一段時間內繼續逐年建設。我想最好的說法是，當我們觀察人們體內血栓的空間時，無論是在頭部、全身或腳趾，我們都會繼續致力於這個空間。我們是──這是我們的重點。

This is our mission, and we are going to continue to develop those markets to focus on that, and it's going to take some time, but in the short term, we're going to have a lot of success. That's why I laid out those numbers. Those are not insignificant opportunities this quarter and next. But in the long run, I think it's going to be much more significant.

這是我們的使命，我們將繼續開發這些市場以專注於此，這將需要一些時間，但在短期內，我們將取得巨大的成功。這就是我列出這些數字的原因。這些在本季和下季都不是微不足道的機會。但從長遠來看，我認為這將更加重要。

Okay. Just lastly, anything with respect to the vascular thrombectomy launches, that is going better or worse in line with your expectations at this point in the launches?

好的。最後，關於血管血栓切除術的任何發布，是否符合您目前發布的預期？

Yes, that's a great question. It's hard to answer that question. I'm a tough critic on our own products. So -- but at the same time, I'm also a believer in our technology and the engineers that have developed it. So better or worse is hard to necessarily judge. What I will say, and I really bring it back to the thing that matter the most to physicians, but mostly in patients is the 3 things that I highlighted. .

是的，這是一個很好的問題。很難回答這個問題。我對我們自己的產品持嚴厲的批評態度。所以，但同時，我也相信我們的技術和開發它的工程師。所以很難判斷是好是壞。我要說的是，我真的把它帶回對醫生來說最重要的事情上，但主要是在病人身上，我強調了三件事。 。

Safety is first. The product has to be safe. Without that, you run into all kinds of topics and issues and so on. So safety, the safety profile of these products has been extraordinary. And that, I think, is one of the things that shows up in our data, but also shows up in talking to physicians about it.

安全第一。產品必須是安全的。如果沒有這一點，你就會遇到各種各樣的話題和問題等等。所以安全性，這些產品的安全性非常好。我認為，這是我們的數據中顯示的事情之一，而且在與醫生談論它時也顯示出來。

The second is speed. No one -- everyone in interventional business knows, the longer you're doing something, the worse it hits. It should -- the best thing is it works really quickly, and you're done. And the speed profile of these is really unparalleled of anything we've ever done or anything that's ever been on the market. And then the final point is simplicity. It has to just be easy, simple to use. You put the one product in, you don't have multiple things or tools. And that's been something that people have really responded to. So again, that is sort of our mantra, that's our guide. We want to make it safe. We want to make -- have speed and we want to have it simple. And having that baseline now with our current CAVT products and knowing that we can even build on that has given us extraordinary confidence, but also a lot of energy that the next period of time is going to be really rewarding for us.

第二是速度。沒有人——介入行業的每個人都知道，你做某件事的時間越長，效果就越糟。它應該——最好的事情是它運行得非常快，然後你就完成了。這些產品的速度是我們做過的任何產品或市場上任何產品都無法比擬的。最後一點是簡單性。它必須簡單易用。您只需放入一種產品，無需使用多種東西或工具。這是人們真正做出反應的事情。再說一次，這是我們的口頭禪，也是我們的指南。我們想讓它安全。我們希望速度快，而且我們希望事情變得簡單。現在我們現有的CAVT 產品已經有了這個基準，並且知道我們甚至可以在此基礎上繼續發展，這給了我們非凡的信心，也給了我們很大的能量，讓我們相信在接下來的一段時間裡我們將真正獲得回報。

Our next question comes from the line of Mike Matson.

我們的下一個問題來自麥克·馬特森。

Just want to follow up on that question about the 1,200 customer accounts. How many of those were not previously number of customers?

只是想跟進有關 1,200 個客戶帳戶的問題。其中有多少不是以前的客戶數量？

Yes. That's actually a great question. I don't -- I can't with the exact specificity give you that number. I can tell you that I know that way more than half, the majority of those 650 accounts and the majority of the following 600 are our new customers. There might be a handful of existing customers in there, but the vast majority are new customers.

是的。這實際上是一個很好的問題。我不知道——我不能準確地告訴你這個數字。我可以告訴你，我知道這 650 個帳戶中的大多數以及接下來的 600 個帳戶中的大多數都是我們的新客戶。那裡可能有少數現有客戶，但絕大多數是新客戶。

Okay. And then -- the one thing that surprised us in '23 was just the strength on the neuro side. I mean, clearly, vascular it looked like it was going to do well given the product cycle. But Thunderbolt has been delayed. So what I'm wondering is looking into next year, do you have anything new coming in neuro to kind of help drive the growth there in '24?

好的。然後，23 年讓我們感到驚訝的一件事就是神經方面的力量。我的意思是，顯然，考慮到產品週期，血管看起來會做得很好。但迅雷卻被延後了。所以我想知道明年的情況，神經方面有什麼新的東西可以幫助推動 24 年的成長嗎？

Yes. I'll start with -- we always have new products in both fields, Neuro as well. I'm not going to comment on them. The core technology is right now, Red 72 SENDit, which it's got a long way to go to continue to drive growth. We're continuing to just as we heard of a physician who had tried it, who typically hadn't been using our aspiration catheters and was particularly blown away by how well it attract. So I think we won yet another customer over. So that's going to drive our success for a while because, again, if you can't get the catheter there, then Thunderbolt doesn't matter. You have to have it be so easy to get there that you're excited to use Thunderbolt.

是的。首先，我們在這兩個領域一直都有新產品，神經領域也是如此。我不會對他們發表評論。目前的核心技術是 Red 72 SENDit，要繼續推動成長還有很長的路要走。我們正在繼續，就像我們聽說一位醫生嘗試過它一樣，他通常沒有使用我們的抽吸導管，並且對它的吸引效果感到特別震驚。所以我認為我們贏得了另一個客戶。因此，這將在一段時間內推動我們的成功，因為，如果你無法將導管放置到那裡，那麼 Thunderbolt 就無關緊要了。您必須能夠輕鬆到達那裡，以至於您對使用 Thunderbolt 感到興奮。

So I think the timing on Thunderbolt is really sets us up so that we can use the time next year to really continue to get in to more and more accounts, which, as you said, we have done pretty well this year. We've taken back significant share, as I said in my prepared remarks, we're now in our estimate, over 55% of the stroke aspiration catheter market. And that is kind of a notable thing that we're competing with 28 other catheters. So usually, when you have that many products all competing -- you don't have a dominant player, if you will. And the fact that we are is a testament to the success we've had this year with RED 72 SENDit, and I don't think that will stop and I think we'll continue with that.

因此，我認為 Thunderbolt 的時機確實為我們做好了準備，這樣我們就可以利用明年的時間繼續獲得越來越多的帳戶，正如您所說，我們今年做得很好。正如我在準備好的演講中所說，我們已經奪回了重要份額，據我們估計，我們現在佔據中風抽吸導管市場超過 55% 的份額。我們正在與其他 28 種導管進行競爭，這是一件值得注意的事情。因此，通常情況下，當你有那麼多產品相互競爭時——如果你願意的話，你就沒有一個主導的玩家。事實上，我們證明了今年 RED 72 SENDit 所取得的成功，我認為這不會停止，我認為我們會繼續這樣做。

Yes. Mike, good question. The only thing I would add, this is Jason, is saw with SENDit the U.S. stroke business have another really strong quarter, double-digit growth this quarter, 20%. And as you know, we don't have yet that product launching anywhere outside the U.S. The other thing I would just note is you're hearing us talk about thrombectomy globally, which includes stroke, obviously, be thrombectomy head to toe vis-a-vis the embolization and access businesses. So I think what you're going to see -- continue to see is thrombectomy, including stroke, but obviously, vascular thrombectomy as well lead our growth. So just pointing that out as you're asking about neuro versus vascular, I think what we're talking about more is thrombectomy vis-a-vis embolization and access.

是的。麥克，好問題。我唯一要補充的是，Jason，透過 SENDit，我們看到美國中風業務又迎來了另一個非常強勁的季度，本季實現了兩位數成長，即 20%。如您所知，我們尚未在美國以外的任何地方推出該產品。我要注意的另一件事是，您正在聽到我們在全球範圍內談論血栓切除術，其中包括中風，顯然，是從頭到腳的血栓切除術-相對於栓塞和通路業務。所以我認為你將會看到——繼續看到的是血栓切除術，包括中風，但顯然，血管血栓切除術也會引領我們的成長。因此，只要指出這一點，當您詢問神經與血管時，我認為我們更多地討論的是血栓切除術與栓塞和通路。

Your next question comes from the line of Matthew O'Brien.

你的下一個問題來自馬修·奧布萊恩。

This is Samantha on for Matt. Just a couple from us. I guess first, on the expected robust growth for thrombectomy and you said 40%. How much could you attribute that to maybe an easier pre-flash comp versus expectations for sequential growth.

這是薩曼莎為馬特代言的。只有我們幾個人。我想首先是關於血栓切除術的預期強勁增長，你說的是 40%。您可以在多大程度上將其歸因於可能是更容易的預閃比較，而不是對連續成長的預期。

Yes. So it's a very good question. Thank you for it. We continue to expect very good sequential growth as well. Comps aside, we're growing significantly faster regardless than I think folks expected in thrombectomy generally and, of course, relative to the market. That's happening both year-over-year and sequentially.

是的。所以這是一個非常好的問題。謝謝你。我們仍然預計會有非常好的環比增長。撇開比較不談，我們的成長速度明顯快於我認為人們對血栓切除術的普遍預期，當然，相對於市場而言。這種情況每年都在發生，而且連續發生。

Okay. And also a question about the VACs. Thank you for all the details there. I was wondering, could you provide any more detail on maybe how many of those facts are kind of double counted for both flash and bolt versus a single flash or just a single bolt.

好的。還有一個關於 VAC 的問題。感謝您提供的所有詳細資訊。我想知道，您能否提供更多詳細信息，說明其中有多少事實對於閃光和螺栓與單個閃光或單個螺栓而言是雙重計算的。

Yes. So that's a really good question, and I apologize for maybe not clarifying. The way we talk about them is each one is a separate accounts. So there -- it's possible, for example, that in the 650 accounts that I said have gotten back approval, but have not yet ordered because they're going through the supply chain process and will soon. Of those, you might have one hospital, but to -- I count it twice because it's bolt and flash. .

是的。所以這是一個非常好的問題，我為可能沒有澄清而道歉。我們談論它們的方式是每個都是一個單獨的帳戶。例如，我所說的 650 個帳戶可能已經獲得批准，但尚未訂購，因為它們正在經歷供應鏈流程，而且很快就會完成。其中，你可能只有一家醫院，但是──我數了兩次，因為它是閃電式的。 。

And sometimes, the same physician is using both products. But in other times, they're not because, as you know, there's interventional cardiologists, vascular surgeons and interventional radiologists who share this and some specialize in certain parts of the body and others don't. So many of those that have one hospital, but 2 submissions, it's separate people who are advocating for those products. It's just a different process. So it's not all lumped in as one, and that's why we count them separately. .

有時，同一位醫生同時使用這兩種產品。但在其他時候，情況並非如此，因為如您所知，介入性心臟病學家、血管外科醫生和介入放射科醫生都有相同的觀點，有些人專注於身體的某些部位，而另一些人則不然。很多人只有一家醫院，但提交了兩份意見，是不同的人在倡導這些產品。這只是一個不同的過程。因此，它們並沒有全部歸為一類，這就是為什麼我們將它們分開計算。 。

(Operator Instructions) Our next question comes from the line of David Rescott.

（操作員說明）我們的下一個問題來自 David Rescott。

I just wanted to start maybe on the neuro thrombectomy segment. I think maybe the comps there were a little bit tougher year-over-year and the numbers came in a little bit below maybe what we were expecting, obviously higher on the peripheral vascular side, but just wondering if there's anything you'd want to call out just on the neuro thrombectomy you talked about. SENDit getting into a position of expanding the market, taking share, maybe having a little pricing benefit there. But just wondering on a cadence basis, year-over-year sequentially. If there's any color you can provide there?

我只是想從神經血栓切除術開始。我想也許那裡的比賽比去年同期更艱難，而且數字可能比我們預期的要低一些，外周血管方面明顯更高，但只是想知道是否有什麼你想要的就你談到的神經血栓切除術大聲疾呼。 SENDit 處於擴大市場、佔領份額的地位，也許還有一點定價優勢。但只是想知道年復一年的節奏。如果有什麼顏色可以提供嗎？

Yes. Thanks, David. This is Jason. So our neuro business achieved our expectations for the quarter, and the team really executed quite well, especially in the United States. So in the United States, the neuro franchise grew 17% year-over-year. I think we've been articulating from the beginning of the year that we expected our vascular business to grow above our total company guidance range, which, of course, has come up from $1 billion to where it is today throughout the year. And we said neuro would grow below this range. .

是的。謝謝，大衛。這是傑森。所以我們的神經業務達到了我們對本季的預期，團隊執行得確實相當好，尤其是在美國。因此，在美國，神經特許經營權比去年同期成長了 17%。我認為我們從今年年初就一直在明確表示，我們預計我們的血管業務將增長到公司總體指導範圍之上，當然，全年指導範圍已經從 10 億美元增長到今天的水平。我們說神經將在這個範圍以下生長。 。

Since we don't give specific guidance by franchise, I think, generally, models may have not accounted for this guidance, perhaps because the neuro growth was higher in the first half of the year. But we fully anticipated neuro growth internationally in the second half of the year would face more seasonality and lower growth in some distributor markets. which is why we gave the guidance context at the beginning of the year that we did.

由於我們沒有按特許經營權提供具體指導，我認為，一般來說，模型可能沒有考慮到這種指導，也許是因為上半年的神經生長較高。但我們充分預期，下半年國際上的神經成長將面臨更多的季節性和一些分銷市場的較低成長。這就是為什麼我們在年初給了指導背景。

So overall, we are quite proud of the progress in our neuro business and continue to expect the new products we have with SENDit and Thunderbolt eventually will fuel our future growth.

因此，總的來說，我們對神經業務的進展感到非常自豪，並繼續期望我們與 SENDit 和 Thunderbolt 合作的新產品最終將推動我們未來的成長。

Okay. Great. Helpful. And then maybe just sticking on that point, taking a step back longer term, I know that newer products put you in the share gain position. When we think about just the overall maybe either U.S. or worldwide neuro thrombectomy market, I know maybe earlier in the year, we saw kind of some of these trials reading out in thrombectomy specifically about maybe expanding the market towards some of the large core in [parked] size patients, more distal occlusions. Just wondering from a higher level, more macro perspective, if the neuro thrombectomy market itself, I said Penumbra is reaccelerating reexpanding or if those are opportunities to drive further growth going forward.

好的。偉大的。有幫助。然後也許只是堅持這一點，從長遠來看，我知道更新的產品會讓你處於份額成長的位置。當我們考慮美國或全球神經血栓切除術市場的總體情況時，我知道也許在今年早些時候，我們看到了一些在血栓切除術中進行的試驗，特別是關於可能將市場擴展到[的一些大型核心]停] 大小的患者，更多的遠端閉塞。只是想從更高的水平、更宏觀的角度來看，我說的 Penumbra 神經血栓切除術市場本身是否正在加速重新擴張，或者這些是否是推動未來進一步成長的機會。

Yes, this is Adam. I think that's a really important question, so I appreciate you raising it. I think that opportunity, particularly on the trials where they're looking at the core impact parked in saying we could treat a lot more of the patients than we thought we could treat is a really huge development. We haven't called that out specifically because we want to wait and see that that's what behavior is happening in sustainable form before we sort of get too excited about it. But I don't disagree with you.

是的，這是亞當。我認為這是一個非常重要的問題，所以我很感謝你提出這個問題。我認為這個機會，特別是在他們正在研究核心影響的試驗中，我們可以治療比我們想像的更多的患者，這是一個非常巨大的發展。我們沒有特別指出這一點，因為我們想等待，看看這就是永續形式正在發生的行為，然後再對此感到過於興奮。但我不同意你的觀點。

I think from everything I've heard and all the conversations I've had with neuro physicians, that is a real likely possibility. It's relatively new. It is sort of summer time and so to talk about it as a clear happening trend, it's a touch early. But I think all the conversations that led to believe that, that could grow the market. Obviously, so far, given the timing of those, the gains we've seen have been share based. But yes, I mean, I would be delighted for patients if we could treat more and more patients and they can get better. And obviously, that would have a very, very positive impact on the neuro part of our thrombectomy business.

我認為從我所聽到的一切以及我與神經科醫生的所有對話來看，這確實是一種可能。這是相對較新的。現在正值夏季，因此將其視為一種明顯的趨勢，還為時過早。但我認為所有的對話都讓我們相信，這可以擴大市場。顯然，到目前為止，考慮到這些的時機，我們看到的收益是基於份額的。但是，是的，我的意思是，如果我們能夠治療越來越多的患者並且他們能夠康復，我會為患者感到高興。顯然，這將對我們血栓切除術業務的神經部分產生非常非常積極的影響。

Next question comes from the line of Shagun Singh.

下一個問題來自 Shagun Singh。

Adam, I was hoping you could provide your views on GLP-1s, just related to (inaudible) preclinical data that is studying GLP-1 impact on peripheral artery disease. The primary and study completion date isn't until mid-2024, but we have seen an impact on stocks in the medtech world just on top line readouts that have come out before. So just anything you can share with us ahead of it to instill confidence in the PAD space.

Adam，我希望您能提供您對 GLP-1 的看法，這些看法與正在研究 GLP-1 對週邊動脈疾病影響的（聽不清楚）臨床前數據有關。初步研究和研究完成日期要到 2024 年中期，但我們僅從先前發布的頂線數據中就可以看出對醫療科技領域股票的影響。因此，您可以在此之前與我們分享任何內容，以增強人們對 PAD 領域的信心。

Yes. Thank you for that question. Obviously, it's been a topic in the investment world, less obviously in the physician community directly. Look, there's -- we're the healthcare company. We obviously applaud any innovation of whatever form that can help people be healthier and feel better. That being said, if you look at just the sort of factual statement, obesity, for example, is not a direct causation of thrombus formation. It is a risk factor. There are lots of risk factors, age and I could list 20-plus risk factors. It is not one of the top risk factors even. But that being said, if you were to look at that and say, maybe you could have a several percentage point impact in the long, long run and the number of patients that have clot, which I'm not willing to necessarily concede but if it did happen, it wouldn't be a material question as it relates to our numbers because we're less than 10% penetrated in a market. And then by the time we were experiencing that, it would be many, many years, if not decades away. .

是的。謝謝你提出這個問題。顯然，這是投資界的一個話題，而在醫生界則不太明顯。看，我們是一家醫療保健公司。顯然，我們對任何能夠幫助人們變得更健康、感覺更好的創新表示讚賞。話雖這麼說，如果你只看事實陳述，例如肥胖，並不是血栓形成的直接原因。這是一個風險因素。風險因素有很多，年齡，我可以列出 20 多個風險因素。它甚至不是最大的風險因素之一。但話雖這麼說，如果你考慮一下這一點並說，從長遠來看，也許你可以對有血栓的患者數量產生幾個百分點的影響，我不一定願意承認這一點，但如果它確實發生了，這不會是一個重大問題，因為它與我們的數字相關，因為我們在市場上的滲透率不到10%。當我們經歷這一點時，即使不是幾十年，也將是很多很多年了。 。

The other analogy and I think for folks who are in stroke or cardiovascular disease of any kind is really looking at statins. 20-plus years ago, they held out huge promise. And obviously, they've been very valuable. They've -- they're -- they become widely adopted. The use of them, very commonplace, the price has come way, way down to very, very affordable. But it hasn't, in any form, it's helped in certain things, but it hasn't changed at all the number of patients who have clot in their body.

另一個類比，我認為對於患有中風或任何類型的心血管疾病的人來說，真正需要考慮的是他汀類藥物。 20多年前，他們做出了巨大的承諾。顯然，它們非常有價值。它們已經——它們——被廣泛採用。它們的使用，非常普遍，價格已經降到非常非常實惠了。但它並沒有以任何形式在某些方面有所幫助，但它並沒有改變體內有血栓的患者數量。

It just hasn't. And so notwithstanding the other benefits that it has brought, it hasn't lowered the number of patients with clot in their body at all. So I think from a -- are we going to be necessary as a company and our innovative products continue to be used at the scale where we have ambition around. I think the answer is pretty clear. We will be.

只是還沒有。因此，儘管它帶來了其他好處，但它並沒有減少體內血栓患者的數量。因此，我認為，作為一家公司，我們是否有必要繼續以我們雄心勃勃的規模使用我們的創新產品？我想答案已經很清楚了。我們將。

Got it. That's really helpful. And just as a follow-up, I wanted to get some color on the plus 20% growth that you've called out in '24. Should we think of that as a base case? It's still -- we haven't entered 2024? And then also, you're exiting the year at 28% to 31% growth in Q4. So what does that imply for '24 and the plus 20% being a base case or let's take this any color that would be helpful.

知道了。這真的很有幫助。作為後續行動，我想對您在 24 年提出的 20% 的成長有一些了解。我們應該將其視為基本情況嗎？還是──我們還沒進入2024年？此外，今年第四季的成長率為 28% 至 31%。那麼這對於“24”和+ 20% 作為基本情況意味著什麼，或者讓我們採用任何有幫助的顏色。

Yes. Look, I don't want anyone to misinterpret what I've said. What I said at the investor conference in September was that 20% plus growth was achievable. And then I reiterated that I strongly believe that today. I also said, please give us the courtesy and time, again, not trying to hide anything, not trying to disallow that, but to get through this year and do what we traditionally do is give formal guidance with the exact numbers on our next quarterly call. Again, please don't read into that, that's somehow anything other than commenting or reiterating what I've already said.

是的。聽著，我不想讓任何人誤解我所說的話。我在9月的投資人會議上說過，20%以上的成長是可以實現的。然後我重申，我今天堅信這一點。我還說過，請再次給我們禮貌和時間，不要試圖隱瞞任何事情，也不要試圖禁止這種情況，而是要度過今年並做我們傳統上做的事情，即在下個季度提供準確的數字正式指導稱呼。再次強調，請不要閱讀這一點，這除了評論或重申我已經說過的話之外還有其他任何內容。

You next question comes from Citigroup.

您的下一個問題來自花旗集團。

It's Joanne Wuensch. And I apologize if you've addressed this. There's a lot going on. Was there any stocking in the quarter? And can you comment a little bit on what you're seeing in terms of -- it looks like there is some neuro weakness and how that happened U.S. versus OUS.

我是喬安妮‧溫施。如果您已經解決了這個問題，我深表歉意。有很多事情發生。本季有備貨嗎？您能否對您所看到的情況發表一下評論——看起來存在一些神經弱點，以及美國與海外國家是如何發生這種情況的。

Yes. Well, let me address the stocking. We quickly addressed that earlier, so I'll do it quickly. We don't typically do stocking. Our initial orders are 1 or 2 units at the most, just to get people started. So that was -- that's not part of our business model and hasn't been. Jason can address. We had a neuro question, which Jason was already asked as well.

是的。好吧，讓我談談襪子。我們之前很快就解決了這個問題，所以我會盡快解決。我們通常不做庫存。我們最初的訂單最多為 1 或 2 個單位，只是為了讓人們開始使用。所以這不是我們商業模式的一部分，也不是。傑森可以講話。我們有一個神經問題，傑森也已經被問過。

Yes, it was, but I'm happy to go through it. So as I mentioned just a little earlier, and apologies for the rest of the people on the call just for going over this again. But our neuro business actually achieved what we expected it to in the quarter. It executed very well. So just to give you a bit more context, the neuro franchise grew 17% year-over-year. And if you remember, we articulated earlier in the year, in fact, at the outset of guidance that we expected vascular growth writ large to be higher than corporate average growth and neuro would be lower.

是的，確實如此，但我很高興經歷它。正如我之前提到的，我對電話會議中的其他人再次討論這個問題表示歉意。但我們的神經業務實際上在本季度達到了我們的預期。它執行得非常好。為了給您更多背景信息，神經系列產品同比增長了 17%。如果你還記得的話，我們在今年早些時候就明確表示，事實上，在指導意見一開始，我們預計血管增長明顯高於企業平均增長，而神經增長將低於公司平均增長。

And we sort of -- I think we got some pushback to that after the first half of the year because neuro was stronger. But we understood the cadence of our business. We understood that we were going to see more seasonality in distributor variances in our neuro business internationally in the second half of the year, which is why we stuck with that. And of course, if we don't guide to specifically to neuro grow this and vascular goes that, I think models just didn't maybe account for that. But in our view, our neuro business and neuro team is doing exceptionally well.

我認為我們在上半年之後遇到了一些阻力，因為神經功能更強了。但我們了解我們業務的節奏。我們知道，下半年我們的國際神經業務的分銷商差異將出現更多季節性，這就是我們堅持這一點的原因。當然，如果我們不專門指導神經生長和血管生長，我認為模型可能無法解釋這一點。但在我們看來，我們的神經業務和神經團隊做得非常好。

And there are no further questions at this time. Ms. Hamlyn-Harris, I turn the call back over to you.

目前沒有其他問題。哈姆林-哈里斯女士，我將電話轉回給您。

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 fourth quarter call.

謝謝你，接線生。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四季電話會議的最新情況。

This concludes today's conference call. You may now disconnect.

今天的電話會議到此結束。您現在可以斷開連線。