Penumbra Inc (PEN) 2023 Q4 法說會逐字稿

Good afternoon. My name is Audra, and I will be your conference operator today. At this time, I would like to welcome everyone to Penumbra's Fourth Quarter and Year-end 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.

午安.我叫奧德拉，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 第四季和 2023 年底的電話會議。 （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 fourth quarter and full year 2023. A copy of the press release and financial tables, which includes the GAAP to non-GAAP reconciliation, can be viewed under the Investors tab on our company website at www.penumbrainc.com.

謝謝運營商，感謝大家參加今天的電話會議，討論 Penumbra 第四季度和 2023 年全年的收益發布。新聞稿和財務表格的副本，其中包括 GAAP 與非 GAAP 調節表，可以可在我們公司網站www .penumbrainc.com 的「投資者」標籤下查看。

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, 2023, which is scheduled to be filed with the SEC on February 22, 2024. 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.

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，實際結果可能與我們的前瞻性陳述中明示或暗示的結果有重大差異，包括我們截至2023 年12 月31 日的10-K 報告中提到的風險和不確定性，該報告計劃於 2023 年12 月31 日向SEC 提交。2024 年2 月 22 日。因此，我們提醒您不要過分依賴這些前瞻性陳述，我們鼓勵您查看我們向SEC 提交的定期文件，包括前面提到的10-K，以更完整地討論這些因素和其他風險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。

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. Non-GAAP operating expenses exclude the amortization of acquired intangible assets and a onetime expense associated with the acquisition of IPR&D and adjusted EBITDA excludes a onetime expense associated with the acquisition of IPR&D and stock compensation.

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。非公認會計準則營運費用不包括所收購無形資產的攤銷以及與收購 IPR&D 相關的一次性費用，調整後的 EBITDA 不包括與收購 IPR&D 和股票報酬相關的一次性費用。

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 fourth quarter and full year 2023; and Jason Mills, our executive Vice President of Strategy, will discuss our 2024 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。隨後，我們的財務長 Maggie Yuen 將討論我們第四季和 2023 年全年的財務表現；我們的策略執行副總裁 Jason Mills 將討論我們的 2024 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 Fourth Quarter and Full Year 2023 Conference Call. Our total revenues for the fourth quarter were $284.7 million, a year-over-year increase of 28.7% as reported and 27.9% on a constant currency basis. For the full year 2023, our total annual revenues were $1,058.5 million, representing growth of 25% as reported and 24.7% in constant currency over full year 2022.

謝謝你，傑。午安.感謝您參加 Penumbra 的 2023 年第四季和全年電話會議。我們第四季的總營收為 2.847 億美元，按報告年增 28.7%，以固定匯率計算成長 27.9%。 2023 年全年，我們的年度總收入為 10.585 億美元，較報告所述增長 25%，按固定匯率計算較 2022 年增長 24.7%。

During the fourth quarter, our global thrombectomy business achieved record revenue of $190.8 million, growing 42.4% as reported and 41.6% in constant currency on a year-over-year basis. Our global embolization and access revenue was $93.9 million, representing increasing 7.6% as reported and 6.7% in constant currency over the same period a year ago. Our U.S. thrombectomy business continued driving outsized growth, increasing 46.4% compared to the same quarter a year ago, driven by continued growth with our computer-assisted vacuum thrombectomy or CAVT products in U.S. vascular thrombectomy. We also delivered more than 20% year-over-year growth in stroke thrombectomy in the U.S. with RED 72 with SENDit technology continuing to set the standard for the market in aspiration catheters and laying the groundwork for Thunderbolt.

第四季度，我們的全球血栓切除業務收入達到創紀錄的 1.908 億美元，按報告計算成長 42.4%，以固定匯率計算年增 41.6%。我們的全球栓塞和通路收入為 9,390 萬美元，按報告計算增長 7.6%，以固定匯率計算比去年同期增長 6.7%。我們的美國血栓切除術業務繼續推動大幅成長，與去年同期相比成長了 46.4%，這得益於我們的電腦輔助真空血栓切除術或 CAVT 產品在美國血管血栓切除術中的持續成長。我們也透過採用 SENDit 技術的 RED 72 在美國實現中風血栓切除術同比增長超過 20%，繼續為抽吸導管市場樹立標準，並為 Thunderbolt 奠定基礎。

We expanded our gross margins in the fourth quarter to 65.7%. We expect to continue expanding gross margins in 2024, owing to favorable product mix and increasing productivity.

第四季我們的毛利率擴大至 65.7%。由於有利的產品組合和不斷提高的生產力，我們預計 2024 年毛利率將繼續擴大。

While we are making important investments to sustain strong growth into the future, we're also delivering increasing profitability. We delivered another record quarter of profitability in the fourth quarter. Non-GAAP operating income was $37.4 million, representing 13.1% of revenue. We posted record adjusted EBITDA of $53.4 million or 18.8% of total revenue, and we grew our operating cash balance by $40.3 million sequentially. We expect to expand our operating profitability in 2024 and beyond, all while we pursue the significant opportunity ahead of us in thrombectomy.

在我們進行重要投資以維持未來強勁成長的同時，我們的獲利能力也在不斷提高。我們在第四季再次實現了創紀錄的季度獲利。非 GAAP 營業收入為 3,740 萬美元，佔收入的 13.1%。我們公佈的調整後 EBITDA 創歷史新高，達到 5,340 萬美元，佔總收入的 18.8%，營運現金餘額環比增加了 4,030 萬美元。我們預計在 2024 年及以後擴大我們的營運獲利能力，同時我們在血栓切除術領域抓住了擺在我們面前的重大機會。

2023 was a watershed year for thrombectomy technology. The defining characteristic about this moment in time in thrombectomy is a confluence of CAVT true second-generation thrombectomy technology and physicians' broadening recognition that this unique platform technology can now successfully treat the majority of both VTE and arterial clot patients. Over the past several months, our expanded base of customers have communicated to us a desire to work together with their hospital systems to expand the pathways of care for their thrombectomy patients. In other words, following 20 years of innovation in thrombectomy technology, now is the time for Penumbra to start doing the next phase of the important work with the health care community to help the vast majority of clot patients who are not yet getting this treatment.

2023年是血栓切除技術的分水嶺。血栓切除術這一時刻的決定性特徵是 CAVT 真正的第二代血栓切除技術與醫生的廣泛認識的融合，即這種獨特的平台技術現在可以成功治療大多數 VTE 和動脈血栓患者。在過去的幾個月裡，我們擴大的客戶群向我們表達了與他們的醫院系統合作的願望，以擴大對血栓切除術患者的護理途徑。換句話說，經過 20 年血栓切除技術的創新，現在是 Penumbra 開始與醫療保健界進行下一階段重要工作的時候了，以幫助絕大多數尚未接受這種治療的血栓患者。

To fulfill the promise of this opportunity for our patients and physicians, we are focused on 3 areas of work, which I began laying out on our third quarter earnings call. They are innovation, internal readiness and market access. These areas of interconnected work are critical to our mission to reach all of these patients. Starting with innovation, Lightning Flash and Lightning Bolt 7 changed the trajectory of treatment in VTE and arterial thrombectomy in the United States during 2023. As many new customers work through the submission process for these transformational products late in the year, we saw the trajectory of our U.S. vascular thrombectomy business accelerate in late November. Coupled with the growth of our commercial team in the U.S., we see this new trajectory as sustainable, as reorder rates for both Flash and Bolt remain as high as any product we've ever launched in thrombectomy.

為了兌現為我們的患者和醫生提供這一機會的承諾，我們重點關註三個工作領域，我在第三季度的財報電話會議上開始闡述了這些工作領域。它們是創新、內部準備和市場准入。這些相互關聯的工作領域對於我們涵蓋所有這些患者的使命至關重要。從創新開始，Lightning Flash 和 Lightning Bolt 7 改變了 2023 年美國 VTE 和動脈血栓切除術的治療軌跡。隨著許多新客戶在今年稍後完成這些變革性產品的提交流程，我們看到了我們的美國血管血栓切除術業務在11 月底加速。再加上我們在美國的商業團隊的成長，我們認為這種新的軌跡是可持續的，因為 Flash 和 Bolt 的再訂購率仍然與我們在血栓切除術領域推出的任何產品一樣高。

As we look into 2024 and beyond, the innovation that delivered Flash and Bolt remains at the core of Penumbra. We recently received FDA clearance for Flash 2.0, the first of our 4 new CAVT products expected over the next 15 months. Flash 2.0 raises the already high bar established just a year ago by Lightning Flash in VTE thrombectomy as 2.0 further optimizes the advantages of CAVT in PE and DVT procedures. Further, the next 3 products will expand the breadth of CAVT's utility to more areas of the body and will enhance the safety, speed and simplicity with which CAVT tackles the variety of clot morphology. In addition, Thunderbolt is progressing very well in THUNDER study, and we are excited to bring the advantages of CAVT to stroke thrombectomy as well, especially with our increasing market share in stroke aspiration catheters.

展望 2024 年及以後，提供 Flash 和 Bolt 的創新仍然是 Penumbra 的核心。我們最近獲得了 FDA 對 Flash 2.0 的批准，這是我們預計在未來 15 個月內推出的 4 個新 CAVT 產品中的第一個。 Flash 2.0 進一步提升了 Lightning Flash 一年前在 VTE 血栓切除術中確立的高標準，因為 2.0 進一步優化了 CAVT 在 PE 和 DVT 手術中的優勢。此外，接下來的 3 個產品將把 CAVT 的應用範圍擴展到身體的更多區域，並將提高 CAVT 處理各種血栓形態的安全性、速度和簡單性。此外，Thunderbolt 在 THUNDER 研究中進展順利，我們很高興也將 CAVT 的優勢應用於中風血栓切除術，特別是隨著我們在中風抽吸導管市場份額的不斷增加。

Further on the innovation front, we are advancing our strategy to leverage the fact that we have a computer chip in every case, dedicated to each individual procedure. Through this important work, we will integrate new technology into the platform that can seamlessly collect valuable information, both procedural and patient specific. This information will be utilized by physicians in real time and in reflection to further enhance treatment and produce efficiencies in patient care that could pay dividends for patients, physicians and hospital systems for many years to come.

在創新方面，我們正在推進我們的策略，以利用我們在每種情況下都擁有專用於每個單獨程式的電腦晶片這一事實。透過這項重要的工作，我們將把新技術整合到平台中，可以無縫地收集有價值的信息，包括程式資訊和患者特定資訊。醫生將即時並反思地利用這些訊息，以進一步加強治療並提高患者護理效率，從而在未來許多年為患者、醫生和醫院系統帶來紅利。

Moving to internal readiness. The fourth quarter was a very important moment in time for Penumbra. The momentum in CAVT with Flash and Bolt in 2023 gave us the opportunity to bring more focus on thrombectomy as well as more scale and efficiency to our vascular sales team. We augmented the capabilities of the team in some areas and increased the size of the team overall. Much of this hiring was accomplished during the fourth quarter with continued hiring and significant training taking place throughout the current quarter.

轉向內部準備。第四節對於半影來說是一個非常重要的時刻。 2023 年 CAVT 與 Flash 和 Bolt 的發展勢頭使我們有機會更加關注血栓切除術，並提高我們血管銷售團隊的規模和效率。我們增強了團隊在某些領域的能力，並擴大了團隊的整體規模。大部分招募工作是在第四季度完成的，本季繼續進行招募和大量培訓。

In addition to our commercial team in the U.S., we continue to make significant progress on efficient manufacturing at scale, which would benefit our gross margins going forward. Given how early we are in the penetration curve for CAVT and thrombectomy, this internal readiness work is timely, important and will continue to evolve.

除了我們在美國的商業團隊之外，我們還繼續在大規模高效製造方面取得重大進展，這將有利於我們未來的毛利率。鑑於我們處於 CAVT 和血栓切除術滲透曲線的早期階段，這項內部準備工作是及時且重要的，並將繼續發展。

The third area of work for us is market access through which we are developing additional evidence to validate the clinical benefit of our CAVT platform and health economic data with which hospital systems can make more informed decisions on treatment paradigms. We believe there are at least 800,000 arterial and VTE thrombectomy patients in the U.S. each year.

我們的第三個工作領域是市場准入，透過市場准入，我們正在開發更多證據來驗證CAVT 平台的臨床效益和健康經濟數據，醫院系統可以利用這些數據就治療模式做出更明智的決策。我們相信美國每年至少有 80 萬名動脈和 VTE 血栓切除術患者。

In order to reach the majority of these patients over the next 5-plus years, our market access work with large hospital systems is critical. With hospital systems partners, we are collecting and analyzing real-world data on an increasing number of CAVT procedures compared to traditional therapies. These initiatives will focus on DVT, PE, arterial and stroke. We believe this work will validate that getting the clot out by optimizing safety, speed and simplicity with CAVT is advantageous to the patient, physician and the hospital system in terms of both clinical outcomes and health economics.

為了在未來五年多的時間裡接觸到大多數患者，我們與大型醫院系統的市場准入工作至關重要。與醫院系統合作夥伴一起，我們正在收集和分析與傳統療法相比越來越多的 CAVT 手術的真實數據。這些措施將重點放在 DVT、PE、動脈和中風。我們相信這項工作將驗證透過優化 CAVT 的安全性、速度和簡單性來取出血栓對於患者、醫生和醫院系統在臨床結果和健康經濟學方面都是有利的。

The benefits from the work we are doing in these 3 areas in 2024 will accrue primarily to our U.S. thrombectomy business. Given that Flash and Bolt 7 have already built momentum, the new products in CAVT are coming first to the U.S. and reimbursement is in place for these procedures. In 2024, we project our U.S. thrombectomy business will deliver 27% to 30% year-over-year growth. While displacing traditional therapies in first-generation mechanical products will drive part of our growth, we believe the work I just described across these 3 areas will move more patients into the system to receive CAVT therapy in 2024 and build even more momentum in the U.S. over the next few years.

到 2024 年，我們在這三個領域所做工作的收益將主要體現在我們的美國血栓切除業務上。鑑於 Flash 和 Bolt 7 已經形成勢頭，CAVT 的新產品將首先進入美國，並且這些程序的報銷已經到位。到 2024 年，我們預計我們的美國血栓切除業務將實現 27% 至 30% 的年成長。雖然在第一代機械產品中取代傳統療法將推動我們的部分成長，但我們相信我剛剛描述的在這3 個領域的工作將使更多患者在2024 年進入系統接受CAVT 治療，並在美國建立更多動力未來幾年。

Outside the U.S., our opportunity with CAVT is also compelling for future years, and we are well into the work with regulatory and reimbursement bodies in Europe, Asia Pacific and Latin America to bring the entire CAVT portfolio to patients outside the U.S. as well. We think we will begin to see the positive impact to our international thrombectomy business in 2025. This strategy and the timing associated with it allows us to not only focus on sustaining long-term revenue growth but also increasing profitability.

在美國以外的地區，未來幾年我們與CAVT 的合作機會也極具吸引力，我們正在與歐洲、亞太地區和拉丁美洲的監管和報銷機構開展深入合作，將整個CAVT 產品組合帶給美國以外的患者。我們認為，到 2025 年，我們將開始看到對我們的國際血栓切除術業務的積極影響。這項策略及其相關的時機使我們不僅能夠專注於維持長期收入成長，而且還能提高獲利能力。

For the last 20 years, the Penumbra team has worked very hard to continuously innovate and in so doing, has built what has become the largest thrombectomy company in the world, removing blood clot from head to toe. This innovation has led to the CAVT platform.

在過去的 20 年裡，Penumbra 團隊非常努力地不斷創新，並由此建立了世界上最大的血栓切除公司，從頭到腳清除血栓。這項創新催生了 CAVT 平台。

Now is the time to start the next phase of the strategy, which we have outlined in detail again today. Our successful execution of this strategy will make our technology available to everyone who can benefit. This work will be hard and will not always be a straight line. However, it will be profound and extremely motivating.

現在是開始戰略下一階段的時候了，我們今天再次詳細概述了該戰略。我們成功執行此策略將使我們的技術可供每個受益者使用。這項工作將是艱苦的，而且並不總是一條直線。然而，這將是深刻且極其鼓舞人心的。

The company is in the best position we've ever been. The Penumbra team is stronger than at any point in our history. And over the next few years, our CAVT products can positively impact the vast untreated patient population in ways no other technology platform has been able to before.

該公司正處於我們有史以來最好的位置。 Penumbra 團隊比我們歷史上的任何時候都更強大。在接下來的幾年裡，我們的 CAVT 產品可以以其他技術平台以前無法做到的方式對廣大未經治療的患者群體產生積極影響。

I'll now turn the call over to Maggie to go over our financial results for the fourth quarter and full year 2023.

我現在將電話轉給 Maggie，討論我們第四季和 2023 年全年的財務表現。

Thank you, Adam. Good afternoon, everyone. Today, I will discuss the financial results for the fourth quarter and full year of 2023. Financial results on this call for revenue and growth 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 年第四季和全年的財務表現。本次電話會議中的收入和成長率利潤率的財務表現是基於GAAP 基礎上的，而營運費用和營運收入是基於非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 財務衡量標準的調整表。

For the fourth quarter ended December 31, 2023, our total revenues were $284.7 million, an increase of 28.7% reported and 27.9% in constant currency compared to the fourth quarter of 2022. Our geographic mix of sales for the fourth quarter 2023 was 71.5% U.S. and 28.5% international.

截至2023 年12 月31 日的第四季度，我們的總營收為2.847 億美元，與2022 年第四季相比，報告成長28.7%，以固定匯率計算成長27.9%。2023 年第四季我們的銷售地理組合為71.5%美國及國際 28.5%。

For the fourth quarter 2023, our U.S. region reported growth of 29.6%, primarily driven by 46.4% year-over-year growth in U.S. thrombectomy. Our international regions increased 26.4% reported and 23.5% in constant currency. The sequential growth in our total revenue of 5.1% was primarily driven by an increase in our global vascular thrombectomy business of $12.2 million or 10.1%.

2023 年第四季度，我們的美國地區成長了 29.6%，主要是由於美國血栓切除術年增 46.4%。我們的國際地區成長了 26.4%，以固定匯率計算成長了 23.5%。我們總收入環比增長 5.1%，主要是由於我們的全球血管血栓切除業務增長 1,220 萬美元，即 10.1%。

Moving to revenue by products. Starting this quarter, we are providing new revenue disclosures that better align with our business. As presented in our press release, we are providing detailed revenue results of our thrombectomy business and our embolization and access business, respectively, in the United States, international and globally. Revenue from our global thrombectomy business grew to $190.8 million in the fourth quarter of 2023, an increase of 42.4% reported and 41.6% in constant currency compared to the same period last year. Revenue from our embolization and access business was $93.9 million in the fourth quarter of 2023, an increase of 7.6% reported and 6.7% in constant currency compared to the same period a year ago.

轉向按產品劃分的收入。從本季開始，我們將提供新的收入揭露，以更好地配合我們的業務。正如我們的新聞稿中所述，我們分別提供了美國、國際和全球血栓切除業務以及栓塞和通路業務的詳細收入結果。 2023 年第四季度，我們的全球血栓切除業務收入成長至 1.908 億美元，與去年同期相比成長 42.4%，以固定匯率計算成長 41.6%。 2023 年第四季度，我們的栓塞和通路業務收入為 9,390 萬美元，與去年同期相比成長 7.6%，以固定匯率計算成長 6.7%。

Before turning to our income statement, I will provide fourth quarter revenue results in the format we have previously used before we transition to the new disclosure format going forward. On a global basis and compared to the fourth quarter of last year, revenue from our vascular thrombectomy was $133.4 million, an increase of 64%, neuro thrombectomy was $57.4 million, an increase of 9%. Vascular embolization was $51.5 million, an increase of 7.3%. Neuro access was $33.2 million, an increase of 18.3%. Neuro embolization was $5.9 million, a decrease of 33.8%, and other revenues were $3.3 million, an increase of 46.3%.

在轉向我們的損益表之前，我將以我們之前使用的格式提供第四季度的收入結果，然後再過渡到新的揭露格式。在全球範圍內，與去年第四季相比，我們的血管血栓切除術收入為1.334億美元，成長64%，神經血栓切除術收入為5,740萬美元，成長9%。血管栓塞費用為5,150萬美元，成長7.3%。神經通路為 3,320 萬美元，成長 18.3%。神經栓塞收入為590萬美元，下降33.8%，其他收入為330萬美元，成長46.3%。

U.S. thrombectomy was our primary growth driver in the fourth quarter and will be in 2024. And we are also being disciplined with our commercial strategy for our embolization portfolio. In sum, we are focused on driving both strong revenue growth and increasing profitability going forward.

美國血栓切除術是我們第四季和 2024 年的主要成長動力。我們的栓塞產品組合的商業策略也受到約束。總而言之，我們未來的重點是推動強勁的營收成長和提高獲利能力。

Turning to gross margin. Gross margin for the fourth quarter of 2023 is 65.7% compared to 62.6% for the fourth quarter of 2022 and 65.6% last quarter. The 300 basis point improvement compared to prior year are driven by higher thrombectomy product mix while cost savings and improvement and productivity and volume leverage have offset labor inflation and material price increases. In 2024, we target improvements of 100 to 150 basis points expansion in gross margin, which reflects continued favorable thrombectomy product mix, investment to support new product launches and variation in regional and distributor mixes.

轉向毛利率。 2023 年第四季的毛利率為 65.7%，而 2022 年第四季為 62.6%，上一季為 65.6%。與前一年相比，這一數字提高了 300 個基點，這是由於更高的血栓切除產品組合推動的，而成本節約和改進以及生產力和產量槓桿抵消了勞動力通膨和材料價格上漲。到 2024 年，我們的目標是將毛利率提高 100 至 150 個基點，這反映出持續有利的血栓切除產品組合、支持新產品發布的投資以及區域和分銷商組合的變化。

Now on to our non-GAAP operating expenses, non-GAAP operating income and margins and adjusted EBITDA. Total operating expense for the quarter was $149.6 million or 52.5% of revenue compared to $131.2 million or 59.3% of revenue for the same quarter last year, and $144.5 million or 53.3% of revenue for last quarter. Our research and development expenses for Q4 2023 were $21.9 million compared to $18 million for Q4 2022 and $21 million for last quarter. SG&A expenses for Q4 2023 were $127.6 million or 44.8% of revenue compared to $113.3 million or 51.2% of revenue for Q4 2022 and $123.5 million or 45.6% of revenue last quarter. Increases in the fourth quarter were driven by an increase in headcount for our U.S. commercial team.

現在我們來看看我們的非公認會計準則營運費用、非公認會計準則營運收入和利潤率以及調整後的 EBITDA。本季總營運費用為 1.496 億美元，佔營收的 52.5%，去年同期為 1.312 億美元，佔營收的 59.3%，上季為 1.445 億美元，佔營收的 53.3%。我們 2023 年第四季的研發費用為 2,190 萬美元，而 2022 年第四季為 1,800 萬美元，上季為 2,100 萬美元。 2023 年第四季的SG&A 費用為1.133 億美元，佔營收的44.8%，而2022 年第四季的SG&A 費用為1.133 億美元，佔營收的51.2%，上一季為1.235 億美元，佔營收的45.6%。第四季的成長是由於我們美國商業團隊人數的增加所致。

We recorded operating income of $37.4 million or 13.1% of revenue in the fourth quarter of 2023 compared to an operating income of $7.2 million or 3.3% of revenue for the same period last year and operating income of $33.2 million or 12.3% of revenue last quarter.

2023 年第四季，我們的營業收入為3,740 萬美元，佔營收的13.1%，而去年同期的營業收入為720 萬美元，佔營收的3.3%，上一季的營業收入為3,320 萬美元，佔收入的12.3% 。

We continue to focus on innovation of our products, commercial evolution of our U.S. sales team to address the increased opportunity in front of us and market access programs in DVT, stroke, arterial and PE, all of which supports an increased number of patients treated. While we continue to spend on these long-term projects that will allow us to scale our organization into the future, we also continue to exercise self-discipline in our other spend in the present. In 2024, we target improvement of 100 to 200 basis point expansion in our operating margin.

我們繼續專注於我們的產品創新、美國銷售團隊的商業發展，以應對我們面前不斷增加的機會，以及DVT、中風、動脈和PE 領域的市場准入計劃，所有這些都支持更多的患者接受治療。雖然我們繼續在這些長期專案上投入資金，使我們能夠在未來擴展我們的組織，但我們也繼續在目前的其他支出上實行自律。 2024 年，我們的目標是將營業利潤率提高 100 至 200 個基點。

We posted record adjusted EBITDA of $53.4 million or 18.8% of total revenue compared to 10.5% in the fourth quarter last year.

我們公佈的調整後 EBITDA 創歷史新高，達到 5,340 萬美元，佔總營收的 18.8%，而去年第四季為 10.5%。

I will now summarize our full year performance for the full year of 2023. Our total revenue for the year was $1,058.5 million, which represents an increase of 25% reported and 24.7% in constant currency compared to full year 2022. Our geographic mix of sales in the year were 71.5% U.S. and 28.5% international. For the full year 2023, U.S. reported growth of 28%, primarily driven by growth from our vascular thrombectomy business of 45.2%, and our international regions increased 18% reported and 17.3% in constant currency.

現在，我將總結我們2023 年全年的業績。我們全年的總收入為10.585 億美元，與2022 年全年相比，報告收入增長了25%，按固定匯率計算增長了24.7%。我們的銷售地理組合今年 71.5% 為美國市場，28.5% 為國際市場。 2023 年全年，美國地區成長了 28%，主要是由於我們的血管血栓切除術業務增長了 45.2%，而我們的國際地區增長了 18%，按固定匯率計算增長了 17.3%。

Revenue from our global thrombectomy business for the full year of 2023 was $677.3 million, an increase of 32.5% reported and 32.3% in constant currency. Revenue from our global embolization and access business, for the full year of 2023 was $381.2 million, an increase of 13.4% reported and 13.2% in constant currency. Revenue from our vascular business for the full year of 2023 was $652.4 million, an increase of 30.6% reported and 30.6% in constant currency. Revenue from our neuro business for the full year of 2023 was $406.1 million, an increase of 16.8% reported and 16.3% in constant currency.

2023 年全年，我們的全球血栓切除業務收入為 6.773 億美元，報告成長 32.5%，以固定匯率計算成長 32.3%。 2023 年全年，我們的全球栓塞和通路業務收入為 3.812 億美元，報告成長 13.4%，以固定匯率計算成長 13.2%。 2023 年全年，我們的血管業務收入為 6.524 億美元，報告成長 30.6%，以固定匯率計算成長 30.6%。 2023 年全年，我們的神經業務收入為 4.061 億美元，報告成長 16.8%，以固定匯率計算成長 16.3%。

Our gross margin for the year was 64.5% of revenue compared to 63.2% of revenue for the full year 2022. We had non-GAAP operating income for the full year of $101.3 million compared to a non-GAAP operating income of $14.4 million for 2022. Our adjusted EBITDA is $170.6 million or 16.1% of total revenue compared to 7.7% last year.

我們全年的毛利率佔收入的 64.5%，而 2022 年全年的毛利率為 63.2%。我們全年的非 GAAP 營業收入為 1.013 億美元，而 2022 年的非 GAAP 營業收入為 1,440 萬美元.調整後的EBITDA 為1.706 億美元，佔總營收的16.1%，而去年為7.7%。

Turning to cash flow and balance sheet. We ended the fourth quarter with cash, cash equivalents and marketable securities balance of $289.2 million and no debt, which is an increase of $40.3 million from last quarter. We expect positive operating cash flow trend to continue in 2024.

轉向現金流和資產負債表。截至第四季末，我們的現金、現金等價物和有價證券餘額為 2.892 億美元，無債務，比上季增加了 4,030 萬美元。我們預計積極的經營現金流趨勢將在 2024 年持續。

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. For 2024, we introduced guidance for total revenue in the range of $1.230 billion to $1.270 billion, representing year-over-year growth of 16% to 20% compared to $1,058.5 million in total revenue in 2023. Primarily based on currently forecasted orders from our international distributors and timing of new product launches, we expect global revenue growth in the first half of the year to be in the mid-teens range. Then, we expect growth to accelerate to the high end of our 16% to 20% guidance range or above in the second half of the year.

謝謝瑪吉，大家下午好。對於 2024 年，我們提出了總收入在 12.30 億美元至 12.70 億美元範圍內的指導，與 2023 年總收入 10.585 億美元相比，同比增長 16% 至 20%。主要基於我們目前預測的訂單考慮到國際經銷商和新產品發布的時機，我們預計今年上半年全球營收成長將在十幾歲左右。然後，我們預計下半年成長將加速至 16% 至 20% 指導區間的高端或更高。

We guide to U.S. thrombectomy revenue growth in the range of 27% to 30% year-over-year. We expect growth in U.S. thrombectomy to be consistently strong in this range throughout the 4 quarters of the year. We expect our U.S. embolization and access business to contribute low double-digit growth in 2024. And therefore, in total, we expect our U.S. business to deliver strong, consistent growth in the 22% to 25% range throughout the year.

我們預計美國血栓切除術收入將年增在 27% 至 30% 範圍內。我們預計美國血栓切除術的成長將在今年四個季度的這一範圍內持續強勁。我們預計我們的美國栓塞和通路業務將在2024 年貢獻兩位數的低成長。因此，總的來說，我們預計我們的美國業務全年將實現22% 至25% 範圍內的強勁、持續成長。

From a geographical distribution perspective, we expect our U.S. business to represent 73% to 75% of our global revenue in 2024. Outside the United States, we have worked the past 2 years to expand the foundation for thrombectomy in our international markets with our legacy products and have made significant progress. In 2024, more of our focus will be on regulatory, reimbursement and market access initiatives to bring our CAVT products to patients outside the United States. As we do this work this year, we expect our international thrombectomy revenue in 2024 to grow modestly over 2023 levels. And as these initiatives come through, we expect to accelerate our international thrombectomy growth in 2025.

從地理分佈的角度來看，我們預計到2024 年，我們的美國業務將占我們全球收入的73% 至75%。在美國之外，過去2 年我們一直致力於利用我們的傳統，在國際市場上擴大血栓切除術的基礎產品並取得重大進展。 2024 年，我們將更專注於監管、報銷和市場准入舉措，將我們的 CAVT 產品帶給美國以外的患者。當我們今年進行這項工作時，我們預計 2024 年的國際血栓切除術收入將比 2023 年的水準小幅成長。隨著這些措施的實施，我們預計到 2025 年國際血栓切除術將加速成長。

Also, on the international front, we are focusing more on driving profitable growth. We plan to continue to be disciplined with our commercial strategy in the near term for our embolization and access products in certain international markets, where prices do not currently reflect the value of our products. At the same time, we are continuing our work with international regulatory and reimbursement agencies with our new products in these areas. In sum, we expect our total international revenue in 2024 to be similar to 2023 levels, and we think our international revenue will accelerate to double-digit growth in 2025.

此外，在國際方面，我們更著重於推動利潤成長。我們計劃在短期內繼續遵守我們在某些​​國際市場上的栓塞和通路產品的商業策略，這些市場的價格目前並未反映我們產品的價值。同時，我們正在繼續與國際監管和報銷機構合作，推出這些領域的新產品。總而言之，我們預計 2024 年的國際總收入將與 2023 年的水平相似，並且我們認為 2025 年我們的國際收入將加速達到兩位數成長。

As a final thought, as we look beyond the current year, as Adam mentioned, we believe our CAVT products will sustain strong growth for the company over the ensuing years.

最後一個想法是，正如 Adam 所提到的，當我們展望今年之後，我們相信我們的 CAVT 產品將在接下來的幾年裡維持公司的強勁成長。

Operator, we can now open the call for questions for the next 35 or 40 minutes.

接線員，我們現在可以在接下來的 35 或 40 分鐘內開始提問。

(Operator Instructions) We'll go first to Joanne Wuensch at Citi.

（操作員指示）我們先去找花旗銀行的 Joanne Wuensch。

Wanted to ask -- I'm curious -- I'm going to ask 2. One, we're hearing about increased payer scrutiny on mechanical thrombectomy. I'm curious how that may or may not be impacting you. And then number two, how do we think about sort of ongoing profitability metrics. I'm finding that comes up more and more on several stocks and medtech, sort of an LRP longer-term view on gross and operating margins.

我想問——我很好奇——我要問2。第一，我們聽說付款人對機械血栓切除術加強了審查。我很好奇這可能會或可能不會影響你。第二，我們如何考慮持續的獲利指標。我發現這種情況越來越常出現在一些股票和醫療科技領域，有點像 LRP 對毛利率和營業利潤率的長期看法。

Yes. First of all, thanks for the good questions. We, in fact, did not -- on mechanical thrombectomy, particularly as we see it, we have not seen the type of, what you're calling, scrutiny. That shows up in other types of procedures that aren't clot, removing blood clots in the cases. So we haven't really seen that. In fact, we saw the opposite this year. In arterial, there were some increases, particularly interesting increases related to hospital outpatient use. So I think we're seeing the opposite.

是的。首先，感謝您提出的好問題。事實上，我們沒有——在機械血栓切除術方面，特別是在我們看來，我們還沒有看到你所說的那種類型的審查。這也出現在其他類型的非凝塊手術中，即去除病例中的血塊。所以我們還沒有真正看到這一點。事實上，今年我們看到了相反的情況。在動脈方面，有一些增加，特別是與醫院門診使用相關的有趣增加。所以我認為我們看到了相反的情況。

As it relates to sort of how we think about profitability, we've outlined, the beginning on this call, our thoughts and plans around how we want to continue to accelerate that by focusing on certain areas where we're not seeing the same sort of price value for some of our embolization access business. So we're going to be disciplined about it. We sort of have, if you will, the luxury of being disciplined about that because we don't need every last dollar revenue when we have the growth of CAVT in the U.S. and coming to the rest of the world in out years.

由於它與我們對盈利能力的看法有關，因此我們在這次電話會議的開頭概述了我們的想法和計劃，圍繞我們希望如何通過關注我們沒有看到相同類型的某些領域來繼續加速這一目標我們的一些栓塞通路業務的價格價值。所以我們會對此嚴格遵守紀律。如果你願意的話，我們可以在這方面遵守紀律，因為當 CAVT 在美國成長並在未來幾年進入世界其他地區時，我們不需要每一美元的收入。

So I think you'll see more and more focus on that without taking away focus on the growth. And I think that's an important -- you're seeing the beginning of that in the last couple of quarters, and I think you'll see that continue pretty strong.

因此，我認為您會看到越來越多的人關注這一點，而不會放棄對成長的關注。我認為這是很重要的——你在過去幾個季度中看到了這種情況的開始，而且我認為你會看到這種情況繼續保持強勁。

And we'll go next Lei Huang.

接下來我們要講的是黃磊。

This is Lei calling in for Larry Biegelsen from Wells Fargo. Can you hear me okay?

我是雷呼叫富國銀行的 Larry Biegelsen。你聽得到我說話嗎？

Yes.

是的。

My question is around the 2024 guidance, the 16% to 20% growth, the midpoint being at 18%. That's quite a bit of deceleration. And thank you for the color on the breakdown. Can you talk a little bit about how to think about the sales cadence through the year just given there are so many different dynamics running through the different segments? And I have a follow-up.

我的問題是關於 2024 年的指導，即 16% 至 20% 的成長，中點為 18%。這是相當大的減速。感謝您提供故障的顏色。鑑於不同細分市場存在如此多不同的動態，您能否談談如何思考這一年的銷售節奏？我有一個後續行動。

Yes. Absolutely, Lei. Let me start by first thing, I -- we stand by our comment that we made actually at your conference last September when our -- and our overall guidance reflects our confidence by projecting that we think 20% growth is achievable. I want to emphasize, though, that we also added a lot more transparency, which you alluded to, by providing guidance of our U.S. thrombectomy business where we project 27% to 30% growth. And that's probably the most important -- the more important number right now since it focuses on our CAVT platform, which is only right now in the U.S. And it also allows us to prepare our international markets in 2024 for our CAVT platform in the future, so we can have similar accelerated growth throughout the world in following years.

是的。絕對是，雷。首先，我們堅持去年 9 月在你們的會議上實際發表的評論，當時我們的整體指導反映了我們的信心，預計我們認為 20% 的成長是可以實現的。不過，我想強調的是，正如您所提到的，我們也透過為我們的美國血栓切除業務提供指導來增加透明度，我們預計該業務將實現 27% 至 30% 的成長。這可能是最重要的——目前更重要的數字，因為它專注於我們的CAVT 平台，目前僅在美國上市，它還使我們能夠為2024 年的國際市場為未來的CAVT 平台做好準備，因此，我們可以在接下來的幾年裡在全世界範圍內實現類似的加速增長。

And that's how we're thinking about the business. And I acknowledge that there's a lot to digest because we've given you a lot of different numbers and talked about our business in a slightly different way, but it's also how we're managing the business. That's how we see the growth. That's where the growth is. That's what the excitement around the opportunity to finally do what we set out to do 20 years ago, which is with this platform, we have visibility. We have the strategy around making sure we can bring this to everyone who has clot in their body from head to toe. We're hearing that from large hospital systems. We're hearing that from customers. We're seeing that in the cases.

這就是我們對業務的思考方式。我承認有很多東西需要消化，因為我們給了你們很多不同的數字，並以稍微不同的方式談論我們的業務，但這也是我們管理業務的方式。這就是我們看待成長的方式。這就是增長所在。這就是我們最終有機會做我們 20 年前打算做的事情所帶來的興奮，透過這個平台，我們有了可見性。我們的策略是確保我們能夠將這種產品帶給每個從頭到腳都有血栓的人。我們從大型醫院系統中聽到了這一點。我們從客戶那裡聽到了這樣的說法。我們在案例中看到了這一點。

So we're trying to focus our energies on that opportunity, and it takes some discipline because that hasn't always been the sole focus of the company. So you're seeing that in how we're thinking about our international business, our coil and access business with that focus right now. But again, what we're thinking about is the other parts of our business matter, but the 27% to 30% growth in U.S. thrombectomy is our focus. And Jason can follow up.

因此，我們正在努力將精力集中在這個機會上，這需要一些紀律，因為這並不總是公司的唯一關注點。因此，您可以從我們目前對國際業務、線圈和接入業務的思考中看到這一點。但同樣，我們考慮的是我們業務的其他部分，但美國血栓切除術 27% 至 30% 的成長才是我們的重點。傑森可以跟進。

Yes. Lei, just to follow up on that with respect to the cadence, so a couple of things I just want to repeat and go over again. We commented about that 27% to 30% in U.S. thrombectomy as well as the entire U.S. business at 22% to 25% delivering pretty consistent growth in that range through the year. So the cadence quarterly is primarily based on distributor order timing to which we have very good visibility as well as timing of product launches as well, to which we have, again, really good visibility, we believe.

是的。雷，我只是想跟進一下節奏，所以有幾件事我想重複一遍。我們評論說，美國血栓切除術佔 27% 至 30%，整個美國業務佔 22% 至 25%，全年在該範圍內實現相當穩定的成長。因此，季度節奏主要基於經銷商訂單時間，我們對此有很好的可見性，以及產品發布的時間，我們相信，我們對此也有很好的可見性。

And so as Adam mentioned, we think that the U.S. thrombectomy number is the number to really look at primarily, and we've commented also that our international business should accelerate in 2025. We have a high degree of confidence in that as well.

正如 Adam 所提到的，我們認為美國的血栓切除術數量是真正值得重點關注的數字，我們也評論說我們的國際業務應該在 2025 年加速。我們對此也有很高的信心。

That's helpful. Just a clarification on what you just said, Jason. So U.S. growth overall is pretty consistent, so it's really the OUS where you're talking about the distributor timing that's driving the mid-teens growth in first half versus second half at 20% or higher. Is that the message there?

這很有幫助。只是對你剛才所說的話進行澄清，傑森。因此，美國的整體成長相當穩定，所以實際上是 OUS（您所談論的分銷商時機）推動了上半年 20% 左右的成長，而下半年則達到了 20% 或更高。那是那裡的消息嗎？

That's correct. And we have very good visibility into the timing. It's just how they land throughout the year.

這是正確的。我們對時間安排有很好的了解。這就是它們全年著陸的方式。

And just for my follow-up, can you talk about your assumptions for the U.S. vascular thrombectomy market growth in terms of what's assumed in your guidance for both venous and arterial?

對於我的後續行動，您能否根據您對靜脈和動脈的指導中的假設來談談您對美國血管血栓切除術市場成長的假設？

Yes. We won't give specific breakdowns between those 2, but the assumption -- the fundamental basis of that is what I've alluded to now for the last month or so -- or 2 that we saw a notable uptick in our trajectory in late November, and that has been consistent. It didn't -- it wasn't a onetime event. It went up, and it stayed at a different level, which gives us the confidence not only in those projections but also in the consistency throughout the year.

是的。我們不會給出這兩者之間的具體細分，但假設 - 其基本基礎就是我在過去一個月左右所提到的 - 或者 2 我們看到我們的軌跡在後期出現了顯著上升十一月，這一直是一致的。事實並非如此——這不是一次性事件。它上升了，並且保持在不同的水平，這不僅讓我們對這些預測充滿信心，而且對全年的一致性也充滿信心。

And the reason for that is what we've been saying throughout most of 2023, which is we had a lot of new customers. We saw a lot of them come through at the end -- the last -- very last days of November and into December, and that's continued. And I think that momentum is continuing, which is why you hear the confidence we have right now in this platform and in this business.

原因是我們在 2023 年的大部分時間裡一直在說，我們有很多新客戶。我們看到很多人在 11 月的最後幾天和 12 月的最後幾天完成了任務，而且這種情況還在繼續。我認為這種勢頭正在持續，這就是為什麼你聽到我們現在對這個平台和這項業務充滿信心。

You add into it the dialogues we're having with hospital systems and physicians, which is just nothing we've ever been able to have before. It gives us an awful lot of confidence that we're headed in the right direction.

你將我們與醫院系統和醫生的對話添加到其中，這是我們以前從未有過的。它給了我們極大的信心，讓我們相信我們正朝著正確的方向前進。

Lei, just to add to that a little bit, in referencing again the U.S. thrombectomy growth of 27% to 30%, we -- that includes VTE, arterial, coronary and stroke. And while we're really excited about cataracts in our stroke portfolios, those -- the growth rates implied for those thrombectomy franchise in the U.S. are lower than that range. VTE and arterial are expected to grow well above that range.

Lei，我想補充一點，再次提到美國血栓切除術增長率為 27% 至 30%，其中包括 VTE、動脈、冠狀動脈和中風。雖然我們對中風組合中的白內障感到非常興奮，但美國血栓切除術特許經營所隱含的增長率低於該範圍。 VTE 和動脈的成長預計將遠高於該範圍。

Part of that strong growth is market growth, which is healthy. Again, market growth is best observed in arrears, I think, but it's still healthy growth. And in addition to that, we expect, of course, to add to our share throughout the year.

這種強勁成長的一部分是市場成長，這是健康的。我認為，市場成長最好是在欠款中觀察到，但它仍然是健康的成長。除此之外，我們當然希望全年增加我們的份額。

We'll go next to Bill Plovanic at Canaccord Genuity.

接下來我們將採訪 Canaccord Genuity 的 Bill Plovanic。

Just some clarity here. So as we look at the U.S. thrombectomy, you launched Flash starting early last year. You launched Bolt soon thereafter. So as we go into the first half of the year, it's actually pretty easy comps as you keep the growth going. It sounds like you're going to keep the growth going and then in the back half of '24, at least in the U.S., it's the sales force changes that really kind of help that growth continue in terms of the market access and all the work you've done on that. Am I thinking about that correctly? And then I have a follow-up.

這裡只是澄清一下。當我們關注美國的血栓切除術時，你們從去年年初就開始推出了 Flash。不久後您就推出了 Bolt。因此，當我們進入今年上半年時，只要保持成長，實際上很容易進行比較。聽起來你會繼續保持成長，然後在 24 世紀後半葉，至少在美國，銷售團隊的變化確實有助於在市場准入和所有方面繼續成長。你在這方面所做的工作。我的想法正確嗎？然後我有一個後續行動。

Yes. Bill, it's Jason. I'll start and maybe Adam can chime in. I -- we had a really strong first quarter last year with Flash, especially early on with our existing customers, and we actually had quite a bit of success with new customers early in that launch as well. Of course, that continued. So I don't know if there are any particular comps to point out that -- 1 quarter outweighing another. And that's why we have pretty good confidence in the consistency with which those grow.

是的。比爾，這是傑森。我先開始，也許 Adam 可以插話一下。去年第一季我們的 Flash 表現非常強勁，特別是在我們現有客戶的早期，實際上我們在發布初期就在新客戶方面取得了相當大的成功以及。當然，這種情況還在持續。所以我不知道是否有任何特定的比較可以指出——一個季度超過另一個季度。這就是為什麼我們對這些成長的一致性充滿信心。

The other thing I would point out is launching Lightning Flash 2.0. Likely a full launch later this quarter really won't impact things until you get into the second quarter. And the other product launches, we're not factoring in too much through the year just to sort of be conservative on that as well.

我要指出的另一件事是推出 Lightning Flash 2.0。在進入第二季度之前，本季稍後的全面發布可能不會真正影響事情。對於其他產品的發布，我們並沒有過多考慮這一年的因素，只是為了在這方面保持保守。

And then on just Thunderbolt, I think some comments you made, I think, earlier in the year. Is that now pushing into 2026 in terms of contributing to the U.S. thrombectomy business?

然後，關於 Thunderbolt，我想您在今年早些時候發表了一些評論。就對美國血栓切除術業務的貢獻而言，現在是否已進入 2026 年？

Yes, Bill, it's a great question. Obviously, I'm going to be careful to give any kind of specificity on a trial that's still ongoing. I think I learned my lesson the last time, so I'm going to resist. The trial is going well. We're enrolling well. The cases are going well.

是的，比爾，這是一個很好的問題。顯然，我會謹慎地對仍在進行的試驗提供任何具體資訊。我想我已經吸取了上次的教訓，所以我要抵制。審判進展順利。我們招生情況很好。案件進展順利。

We said during that time when we were resetting expectations around the timing of Thunderbolt that we have not put in our number for '24 or '25 any Thunderbolt revenue. And so that was what we said then. That's still true. Whether or not it comes or not, we'll deal with that at the time. But we're not counting on Thunderbolt revenue until '26 anyway, and I said that over a year ago or whenever that last was. So that's stayed consistent.

我們在重新調整有關 Thunderbolt 時間的預期時表示，我們沒有將 24 或 25 年的任何 Thunderbolt 收入納入我們的數字中。這就是我們當時所說的。這仍然是事實。不管它來不來，到時候我們都會處理。但無論如何，我們直到 26 年才指望 Thunderbolt 的收入，我是在一年前或最後一次說的。所以這保持一致。

So this is -- the growth that we're talking about is -- in CAVT is on -- with Flash and Bolt and the new products going forward. And obviously, our stroke growth, which was -- if I want to -- it's significant in the fourth quarter. We continue to take share. A lot of that is really just on the extraordinary success, continued success of Red 72 with SENDit, which is, as I said, just setting the standard.

所以這就是——我們正在談論的成長——CAVT 正在發生——Flash 和 Bolt 以及新產品的不斷發展。顯然，如果我願意的話，我們的中風成長在第四季非常顯著。我們繼續分享。這很大程度上取決於 Red 72 與 SENDit 取得的非凡成功和持續成功，正如我所說，這只是設定了標準。

That is the catheter of choice now. We've gained more and more share, and I think it's setting the table for Thunderbolt because, again, you need that catheter first, and then you can use Thunderbolt afterwards. So again, we remain very optimistic about the sort of 1-2 punch there with those 2 products.

這是現在選擇的導管。我們已經獲得了越來越多的份額，我認為這為 Thunderbolt 奠定了基礎，因為您首先需要導管，然後才能使用 Thunderbolt。因此，我們仍然對這 2 個產品的 1-2 次衝擊保持非常樂觀。

And a point of clarification on international if I could. Is -- are you going to discontinue selling some products in some countries in the first half of this year? Is that what some of the delays and kind of the downdraft in OUS?

如果可以的話，請澄清一下國際問題。今年上半年你們是否打算停止在某些國家/地區銷售某些產品？這就是 OUS 的一些延誤和下滑嗎？

What we said was that in our embolization and access business, there are certain countries where reimbursement pricing just isn't commensurate with sort of the value of the product, and we're not -- it's not a profitable business. So we are using this opportunity, if you will, with the success that we're having, where we don't need to do that, and they can use products that are more commensurate with what they want to pay for. And so yes, the answer is there are certain areas and countries that, that is true, so we are going to focus on profitability in those markets.

我們所說的是，在我們的栓塞和通路業務中，在某些國家/地區，報銷定價與產品的價值不相稱，而我們不是——這不是一項有利可圖的業務。因此，如果你願意的話，我們正在利用這個機會，我們正在取得成功，我們不需要這樣做，他們可以使用與他們想要支付的費用更相稱的產品。是的，答案是某些地區和國家確實如此，因此我們將重點放在這些市場的獲利能力上。

We'll take our next question from Robbie Marcus of JPMorgan.

我們將接受摩根大通的羅比·馬庫斯提出的下一個問題。

I want to ask -- and I don't want to belittle 29% growth at all because it's a great growth rate, but this is the first time you've missed Street numbers since the IPO. And I would say at our conference in January, you didn't comment on the quarter, but you did sound pretty robust. So what happened during the quarter that you ended up missing the midpoint of your guidance range and the sell-side numbers?

我想問——我根本不想貶低 29% 的增長率，因為這是一個很高的增長率，但這是自 IPO 以來你第一次錯過街道數據。我想說的是，在一月份的會議上，您沒有對本季發表評論，但聽起來確實相當穩健。那麼，本季發生了什麼導致您最終錯過了指導範圍和賣方數據的中點呢？

Yes. What you just said is true, but our Q4 revenue number, it was within our guidance, but obviously, it's still just shy of the consensus number. However, what led to my excitement at your conference, what led to my excitement every single day since then into now is the very -- sort of the fact that -- and I said it again today day. We saw a notable uptick in our trajectory in late November, and that's continued since then, which gives us the visibility, Robbie, and the confidence to guide our U.S. thrombectomy business to see a 27% to 30% growth in the U.S. this year.

是的。你剛才說的是真的，但我們第四季的收入數字在我們的指導範圍內，但顯然，它仍然低於共識數字。然而，是什麼讓我在你們的會議上感到興奮，是什麼讓我從那時到現在的每一天都感到興奮的是這個事實——我今天又說了一遍。我們在11 月底看到了我們的發展軌跡顯著上升，從那時起這種情況一直持續著，羅比，這給了我們知名度，也讓我們有信心引導我們的美國血栓切除業務今年在美國實現27% 至30% 的成長。

What's not to like about that? That gives us an extraordinary amount of confidence about 2024 and beyond with the success of this. And we were waiting for this moment. All these new accounts were coming. They were -- and we saw that sort of moment happen. So what's not to be liked? And yes, I acknowledge, without a doubt, that there's a couple of million dollars short from the consensus, still within our guide. But I will assure you, our entire team here is totally focused on 2024 and succeeding with the CAVT platform.

有什麼不喜歡的呢？這讓我們對 2024 年及以後的成功充滿信心。我們正在等待這一刻。所有這些新帳戶都來了。他們是──我們看到了那個時刻的發生。那什麼是不被喜歡的呢？是的，我毫無疑問地承認，距離共識還差幾百萬美元，但仍在我們的指導範圍之內。但我向您保證，我們整個團隊完全專注於 2024 年並透過 CAVT 平台取得成功。

Great. And maybe to follow up on a question from before about cadence. The U.S., you said, should be within the guidance range pretty much throughout the year. OUS, lower at the beginning, higher at the end due to stocking. How do we think about the amount of stocking that were in the different quarters? Because when we just look from the outside, we see much more difficult comps in the back part of the year versus the first and higher dollar values. So how do we think about what the amount of stocking is, so we could get a sense of underlying volume?

偉大的。也許是為了跟進之前關於節奏的問題。您說，美國全年幾乎都應該處於指導範圍內。 OUS，因庫存原因，初低，末高。我們如何看待不同季度的庫存量？因為當我們只從外部觀察時，我們會發現今年下半年的表現比第一年和更高的美元價值要困難得多。那麼我們如何考慮庫存量是多少，以便我們能夠了解潛在的成交量呢？

Yes, it's a great question. Let me just make sure our terminology is sort of right if you will. We don't really do stocking as that word is sort of sometimes considered and used. What we're talking about in most of these international markets, not all because we're direct in parts of Europe and so on, but is really distributor orders.

是的，這是一個很好的問題。如果您願意的話，讓我確保我們的術語是正確的。我們並不真正做“放養”，因為有時會考慮和使用這個詞。我們在大多數國際市場中談論的並不是因為我們直接進入歐洲等地區，而是真正的經銷商訂單。

Distributors tend to order -- they are slightly different. Some have different ordering patterns. We've seen this now. They're not linear. They don't order every week. They order, most of the time, quarter-by-quarter, but sometimes even less than that. And then they get -- they then go sell it. We get those orders and those forecasted orders from them. We don't give them numbers. We get those in advance. And from those projected, forecasted orders, we then put it into our number.

分銷商傾向於訂購——它們略有不同。有些有不同的訂購模式。我們現在已經看到了這一點。它們不是線性的。他們不是每週都訂購。大多數時候，他們按季度訂購，但有時甚至少於這個數量。然後他們就去賣掉它。我們從他們那裡獲得這些訂單和預測訂單。我們不給他們數字。我們提前得到這些。然後，根據這些預計的訂單，我們將其放入我們的數字中。

All -- on the thrombectomy side, all of those folks -- I should say, the vast majority of those folks know that CAVT is coming. So obviously, they're going to be careful and not order as much product when they know a better generation is coming because they don't want to be left with excess inventory. That's just obvious and common sense. So we're taking that into account and being thoughtful about it.

所有——在血栓切除術方面，所有這些人——我應該說，絕大多數人都知道 CAVT 即將到來。顯然，當他們知道更好的一代即將到來時，他們會小心謹慎，不會訂購那麼多的產品，因為他們不想留下過多的庫存。這是顯而易見的常識。所以我們正在考慮這一點並深思熟慮。

The other part of it relates to the coil business, the embolization and access business. And I've already sort of addressed that, that this is an opportunity now with us to focus that business in a way that allows us to retain our growth and profitability without really losing anything in the long, long run. So some of those are sort of dipping away, are negative, and we're just putting that into a lot of transparency, which, again, brings me back to the best measure is our latest technology and the growth curve that we're having because not only are we going to continue to have that for number of years, we think, in the U.S. We think that will be replicated in the international markets when those products get there. That's really the good thing. So we're getting the business ready to go in those international markets where we can have that kind of growth, too.

另一部分涉及線圈業務、栓塞和通路業務。我已經解決過這個問題，現在我們有機會專注於業務，使我們能夠保持成長和盈利能力，而從長遠來看，不會真正損失任何東西。因此，其中一些正在逐漸消失，是負面的，我們只是將其投入到大量的透明度中，這再次讓我回到最好的衡量標準是我們最新的技術和我們擁有的增長曲線因為我們認為，我們不僅會在美國繼續這種情況很多年，而且當這些產品到達國際市場時，我們認為這種情況也會在國際市場上複製。這確實是好事。因此，我們正在準備業務進入那些我們也可以實現這種成長的國際市場。

And Adam, if I could just sneak in the size of those discontinued country sales.

亞當，如果我能偷偷透露那些已停產的國家/地區的銷售規模。

When you add it all up, it gets you to the numbers that we were alluding to. I don't think by calling out each country is -- and the size feels right on a public call. Those are great partners and great countries, and I think we can get to the same number without calling them out country by country. But I appreciate the question.

當你把它們全部加起來時，你就會得到我們提到的數字。我不認為透過公開呼籲每個國家都可以——而且在公開呼籲中，規模大小感覺合適。這些都是偉大的合作夥伴和偉大的國家，我認為我們可以達到同樣的數字，而無需逐一列舉。但我很欣賞這個問題。

We'll move next to Pito Chickering at Deutsche Bank.

我們將搬到德意志銀行的 Pito Chickering 旁邊。

One quick clarification. Just looking at the comments from sort of 3Q of at least 20% growth for 2024 and then guidance today, is the only difference between your commentary previously and where we are today is just slower international growth because you're focused on profitability? Or is there anything else?

快速澄清一下。只要看看對 2024 年第三季度至少 20% 增長的評論以及今天的指導，您之前的評論和我們今天的情況之間的唯一區別是否只是國際增長放緩，因為您專注於盈利能力？或是還有其他什麼嗎？

Yes. I think you've got it. That question implies you're really focusing on both the 27% to 30% growth in U.S. thrombectomy as well as taking that a step further with the entire portfolio of neuro access, embolization, et cetera, at 22% to 25% growth.

是的。我想你已經明白了。這個問題意味著您確實關注美國血栓切除術 27% 至 30% 的增長，並進一步關注神經通路、栓塞等整個產品組合的 22% 至 25% 增長。

And yes, the discipline we've talked about here with respect to certain international markets and timing is something we've been working on now for a little while and we've seen a little bit of as well in 2023. So we have pretty good visibility into this, but I think that is the difference that you've noted.

是的，我們在這裡討論的關於某些國際市場和時機的紀律是我們現在已經努力了一段時間的事情，我們在 2023 年也看到了一些。所以我們有相當多的對此有很好的了解，但我認為這就是您注意到的差異。

And then can you talk about the sales force for a minute? How many sales guys have you hired? What was the cadence of that hiring throughout the last 12 months? Where is the sales force, those new reps ramping up versus the demand? And do you have the right sales force today in order to meet your '24 guidance? Or do you need to hire more? And then last question, are you seeing any churn of seasoned sales force because of the new adds? Or is it looking pretty good?

然後您能談談銷售人員嗎？您僱用了多少銷售人員？過去 12 個月的招募節奏是怎麼樣的？銷售隊伍在哪裡，那些新的銷售代表在哪裡以滿足需求？您現在是否擁有合適的銷售團隊來滿足您的 '24 指導方針？或者您需要雇用更多人嗎？最後一個問題，您是否看到經驗豐富的銷售人員因新增人員而流失？或是看起來還不錯嗎？

I tried to write them all down. There's a long list of questions, so let me -- if I missed one of the specific ones, please reask it. As I said in the prepared remarks, most but not all of the hiring is done. The majority of it is. Now we're focused on getting them all trained and operated.

我試著把它們全部寫下來。問題清單很長，所以讓我——如果我錯過了其中一個具體問題，請重新提出。正如我在準備好的演講中所說，大部分但不是全部招募工作已經完成。大部分是。現在我們的重點是讓他們全部接受訓練和操作。

I will tell you from years of doing this, this was the most seamless as it related to moving around territories, bringing in new folks than any other expansion we've had. And that's in large part because our team, I think, very maturely and sort of as a professional understood that they will actually benefit more in the long run as will our patients by having the ability to focus on less accounts.

我會告訴你，從多年來的做法來看，這是最無縫的，因為它涉及在地區之間的移動，比我們任何其他擴展都引入新人。我認為，這在很大程度上是因為我們的團隊非常成熟，並且作為專業人士了解，從長遠來看，他們實際上將受益更多，我們的患者也將受益於能夠專注於更少的帳戶。

We have a lot to do. We have very large territories, much larger than our competitors, which is also why we don't give out our sales force numbers. And that has been part of our advantage. It stays that way. But with all of the work ahead and these 2 big launches and the growth ahead, we just needed more people. We probably should have done it a day or 2 earlier. Had that happened, it would have turned out differently. But it's gone really, really well, and it's been a sort of a remarkable sort of integration.

我們有很多事情要做。我們擁有非常大的領土，比我們的競爭對手大得多，這也是我們不透露銷售人員人數的原因。這是我們優勢的一部分。它保持這樣。但隨著未來的所有工作以及這兩項重大發布和未來的成長，我們只需要更多的人。我們可能應該提前一兩天完成。如果發生這種情況，結果就會有所不同。但它進展得非常非常好，這是一種非凡的整合。

The other thing and part of the reason for that is we have attracted the sort of most talented, most seasoned sales reps from other peripheral vascular companies that we've ever attracted. And I think part of that is just on the success of the CAVT products and what they know and hear so that the professionalism, the ability to move in and pick up quickly has been pretty remarkable.

另一件事也是部分原因是我們吸引了來自其他週邊血管公司的最有才華、最經驗豐富的銷售代表。我認為部分原因在於 CAVT 產品的成功以及他們所知道和聽到的，因此專業、快速融入和接手的能力非常出色。

So it's gone well. It obviously takes some effort to train them and get them started and so on. We've had training classes and all that. But in the long run, I think it's been one of the easiest things.

所以一切都很順利。顯然需要付出一些努力來培訓他們並讓他們開始等等。我們參加過培訓班等等。但從長遠來看，我認為這是最簡單的事情之一。

As it relates to our current projected growth, this is the team that will get us there. Obviously, as that continues to go, and the market access projects that we're working on bear fruit, we might need to evolve that as well. But for now through this year, I think we're in really good shape.

由於它與我們當前的預期成長相關，因此這個團隊將幫助我們實現這一目標。顯然，隨著這種情況的持續發展，以及我們正在進行的市場准入計畫取得成果，我們可能也需要對此進行改進。但從現在到今年，我認為我們的狀態非常好。

We'll take our next question from Matthew O'Brien at Piper Sandler.

我們將接受 Piper Sandler 的 Matthew O'Brien 提出的下一個問題。

This is Samantha on for Matt. I guess, first, I would like to touch on -- go back and touch on guidance a bit. So I guess the lower end of the revenue guidance, the 16%, what does that scenario consider or bake in compared to the top end of the range?

這是薩曼莎為馬特代言的。我想，首先，我想回顧一下指導。所以我猜收入指導的下限是 16%，與該範圍的上限相比，這種情況考慮或考慮了什麼？

Yes, I'll start, and then Adam can join in. Obviously, we have a range for U.S. thrombectomy where there's a low end and a range for our U.S. business, which would contemplate our expectations for what U.S. embolization and access, too, that also has a low end, 27% and 22%, respectively. And it's probably hard on a call where we have finite time to go through every detail on what drives the lower, the higher end or above of each one of those numbers. But in every event, it is market growth. It is things like that. Internationally, I think we have pretty good visibility, but of course, you let the year play out. So I don't think there's anything demonstrable to point out between the low or upper end. It's just execution at the end of the day.

是的，我會開始，然後 Adam 可以加入。顯然，我們有一系列美國血栓切除術，其中有一個低端和一個針對我們美國業務的範圍，這也將考慮我們對美國栓塞和獲取的期望，也有一個低端，分別為27% 和22%。在電話會議上，我們的時間有限，要詳細了解導致每個數字較低、較高或較高的因素，這可能會很困難。但無論什麼情況，都是市場成長。就是這樣的事情。在國際上，我認為我們有很好的知名度，但當然，你要讓這一年繼續下去。所以我認為在低端和高端之間沒有任何明顯的區別。這只是一天結束時的執行。

And then one thing -- I guess, one of the bright spots for us this quarter was the EBIT was higher than we were expecting. I guess where do you kind of see the margins moving in the long term?

然後有一件事 - 我想，本季我們的亮點之一是息稅前利潤高於我們的預期。我想從長遠來看，您認為利潤率會發生什麼變化？

I think, yes, we're very pleased with our profitability this year. I mean it kind of demonstrate that we can scale and continue to invest at the same time. Our gross margin, we're continuing seeing favorable product mix. So we are on track to our longer-term 70-plus percent margin target. And I'm pretty sure that we'll pull through to the bottom line. And we will continue to invest, but I think we are setting up for very good infrastructure to scale.

我認為，是的，我們對今年的獲利能力非常滿意。我的意思是，這表明我們可以同時擴大規模並繼續投資。我們的毛利率繼續看到有利的產品組合。因此，我們正在朝著 70% 以上的長期利潤率目標邁進。我非常確定我們會堅持到底。我們將繼續投資，但我認為我們正在建立非常好的基礎設施以進行擴展。

We'll take our next question from Michael Sarcone at Jefferies.

我們將回答 Jefferies 的 Michael Sarcone 提出的下一個問題。

So just for the first one, do you think you can give us an update on the status of the VAC processes that you're working through with Flash and Bolt? I would just love to get an update there.

那麼，對於第一個問題，您是否可以向我們介紹您正在使用 Flash 和 Bolt 進行的 VAC 流程的最新狀態？我只是想在那裡得到更新。

Yes. It's a great question. So obviously, the uptick that we saw starting in late November and continuing assumes that more -- a lot more of those customers have come onboard and started using the products. So we're just like we said we were in the third quarter, i.e., we're getting through a lot of those. We still have some to go. We're not obviously in every account in the country, and we have more coming. But a big bolus of those came in late November and into December, which is what we had hoped for. And now we're seeing the benefit of that. And as we continue, the focus now is, yes, on continuing getting the remainder but really focuses on moving to getting the physicians up and running and using the product on a regular basis.

是的。這是一個很好的問題。很明顯，我們從 11 月底開始看到的成長並持續下去，假設有更多的客戶已經加入並開始使用這些產品。所以我們就像我們在第三季所說的那樣，也就是說，我們正在經歷很多這樣的事情。我們還有一些路要走。顯然我們並沒有出現在這個國家的每個帳戶中，而且我們還會有更多的帳戶。但其中一大批是在 11 月底和 12 月到來的，這正是我們所希望的。現在我們看到了這樣做的好處。隨著我們的繼續，現在的重點是，是的，繼續獲得剩餘的產品，但真正的重點是讓醫生開始運作並定期使用該產品。

So it's a really good phase. Some of that administrative part is done and derisked. And now we're just enjoying the early text cases -- we get texts from reps in the early cases and how they're all going and pictures of clot and excitement and so on. So we're moving into that phase, which is a lot more fun than the heavy burden of the administrative load there.

所以這是一個非常好的階段。其中一些管理部分已經完成並消除了風險。現在我們只是享受早期的文本案例 - 我們從早期案例中的代表處獲得文本以及他們的進展情況以及凝塊和興奮的圖片等等。因此，我們正在進入這個階段，這比那裡繁重的管理負擔有趣得多。

And then just last one for me. Could you give us any more color on the different bells and whistles you've added to the Flash 2.0? I think you said it optimizes the advantages of CAVT. But anything that could help us crystallize that more?

然後是我的最後一個。您能為我們提供更多有關您添加到 Flash 2.0 中的不同花哨功能的資訊嗎？我想你說它優化了CAVT的優點。但有什麼可以幫助我們進一步明確這一點嗎？

Yes, I think you would frame it the following way. We get more clot out faster with even less blood loss than before.

是的，我想你會按照以下方式建造它。我們可以更快地排出更多血塊，並且失血量比以前更少。

And next, we'll move to Richard Newitter at Truist Securities.

接下來，我們將邀請 Truist 證券公司的 Richard Newitter。

Maybe just on the guidance and the philosophy there, Adam, Jason. The 2024 guide, particularly with respect to the U.S., you're kind of very accountable on the metrics there, the revenue breakdown. Thank you for that. I guess what I'd like to know, going off Robbie's question earlier, what philosophically is your approach to guidance this year, last year and in the fourth quarter? You came close, but it wasn't necessarily upside relative to the guide or the consensus.

也許只是關於那裡的指導和哲學，亞當，傑森。 2024 年指南，特別是關於美國的指南，您對那裡的指標（收入細目）非常負責。謝謝你。我想我想知道的是，拋開羅比之前的問題，你們今年、去年和第四季的指導方針是什麼？你已經很接近了，但相對於指南或共識來說，這並不一定有好處。

So how should we think about your approach to this year? And I'm particularly talking about the U.S. thrombectomy numbers because that's where I think you're going to be graded the hardest. Is this aspirational? Is this a floor? What can you give us in terms of how much cushion is built in and how you set your -- up for better expectations, management and execution?

那我們該如何看待你今年的做法呢？我特別談論美國的血栓切除術數字，因為我認為這是最困難的。這是有抱負的嗎？這是地板嗎？在內建多少緩衝以及如何設定更好的期望、管理和執行方面，您能為我們提供什麼？

So I would comment that we're running out of time on your pun, the fact that our guide is aspirational, and that's the products we sell. I don't think you intended that pun, but I appreciate the effort if you did. The fact is this. We learned a lot. Last year was a great year for us. We learned a lot. We have not had a year that had the scale of growth and excitement around our product in our company's history. And so it was really hard to figure that out. How do we get the kind of information that can give proper guidance and so on. And we came really close, and I'm pretty proud of that given the scale of growth in the transformational aspect of last year.

所以我想說的是，我們已經沒有時間來理解你的雙關語了，事實上我們的指南是有抱負的，這就是我們銷售的產品。我不認為你有意使用這個雙關語，但如果你這樣做的話，我很感激你所付出的努力。事實是這樣的。我們學到了很多。去年對我們來說是偉大的一年。我們學到了很多。在我們公司的歷史上，我們還沒有遇到像我們產品這樣規模的成長和令人興奮的年份。所以真的很難弄清楚這一點。我們如何獲得那種訊息，可以給予正確的指導等等。我們非常接近，考慮到去年轉型方面的成長規模，我對此感到非常自豪。

Obviously, better to hit the number and move on, but in the long run, it is not as important as having the foundation to continue to grow from year-over-year. So we've learned a lot, and I think we're going to be more careful, thoughtful about it. We understand these products better. We understand the rhythm of them, the level of interest. We're further into it. So we have a lot more information. So our philosophy is to not guide aspirationally, to use your term, but to really guide with the kind of clarity and information that we've done in the past. And again, I think you'll see that in 2024.

顯然，最好是達到目標並繼續前進，但從長遠來看，這並不像擁有繼續逐年增長的基礎那麼重要。所以我們學到了很多東西，我想我們會更小心、更深思熟慮。我們更了解這些產品。我們了解他們的節奏和興趣程度。我們正在進一步研究它。所以我們有更多的資訊。因此，我們的理念不是用你的術語來進行有抱負的指導，而是以我們過去所做的那樣的清晰度和信息來真正進行指導。我想你會在 2024 年看到這一點。

We'll go next to David Rescott at Baird.

我們將前往貝爾德的大衛雷斯科特 (David Rescott)。

Two questions. I'll ask them both upfront. First, I heard you call out Flash 2.0. I think maybe specifically, you talked a little bit about expanding to more areas in the body. So just wondering specifically what some of those comments kind of mean? And then should we think about maybe a Bolt 2.0?

兩個問題。我會提前問他們兩個。首先，我聽到你提到Flash 2.0。我想也許具體來說，你談到了擴展到身體的更多區域。所以只是想知道其中一些評論的具體含義是什麼？那我們是否應該考慮 Bolt 2.0？

And then my second question, just on international. It sounds like obviously 2024 is the big investment. I think I heard you call out seeing that accelerate in 2025 to a double-digit range. Just wondering if that growth outlook into 2025 for international is something that would be maybe accretive or just maybe more supportive of the total top line growth of the company?

然後是我的第二個問題，關於國際。聽起來顯然 2024 年是一筆巨額投資。我想我聽到你喊道，到 2025 年，這一速度將加速至兩位數。只是想知道 2025 年國際業務的成長前景是否會促進公司的整體營收成長，或者只是更有利於公司的整體營收成長？

Let me start and then Jason can sort of touch on the question around '25 and so on. The products, I'm not going to be more specific than I have been about where we think -- what these products are going to do. What I can tell you is the following. I've had the opportunity to hear about them, to see them, to talk to the folks who are designing them and playing with them. I'm really excited about it. The goal again is simple.

讓我開始，然後 Jason 可以談談 25 年左右的問題等等。對於產品，我不會比我們的想法更具體——這些產品將做什麼。我可以告訴你的是以下內容。我有機會聽到、看到它們、與設計它們並使用它們的人交談。我對此感到非常興奮。目標又很簡單。

We want to be able to go after every kind of clot in as much of the body as we can go. These new products do that. They expand that opportunity to get different types of clots in different parts of the body. And sometimes both. Sometimes just one of those. That's the goal. And I can't wait. I think we now have understood this. This platform of CAVT has totally changed how we're thinking about this, what we think we can go after, how we can continue to improve the algorithms.

我們希望能夠盡可能追蹤身體各部位的各種血栓。這些新產品就是這樣做的。他們擴大了在身體不同部位形成不同類型血栓的機會。有時兩者兼而有之。有時只是其中之一。這就是目標。我等不及了。我想我們現在已經明白了這一點。 CAVT這個平台徹底改變了我們的思考方式，我們認為我們可以追求什麼，以及我們如何繼續改進演算法。

And so the goal here is to be able to go after clot in any part of the body with a lot of confidence that we can get it out, and that's what those products bring us even closer to. When those are done, we're not going to be done. We're going to keep adding. We'll keep innovating. We'll keep adding 3.0, 4.0 because that's how great technology works. And I think we're set up for a pretty nice run here.

因此，我們的目標是能夠充滿信心地清除身體任何部位的血栓，我們可以將其清除，而這正是這些產品使我們更接近的目標。當這些完成後，我們還沒有完成。我們將繼續添加。我們將不斷創新。我們將繼續增加 3.0、4.0，因為這就是偉大技術的運作方式。我認為我們已經準備好在這裡進行一場漂亮的比賽了。

Yes. And David, thanks for your second question. In my prepared remarks, I talked about the international business, and I mentioned 2025, and you're right. We did say in those prepared remarks that we thought that international revenue could accelerate into the double digits in 2025.

是的。大衛，謝謝你的第二個問題。在我準備好的發言中，我談到了國際業務，我提到了2025年，你是對的。我們在準備好的演講中確實說過，我們認為 2025 年國際收入可能會加速達到兩位數。

And then the next comment that we made was about our CAVT products and sustaining strong growth because the reality is, even hitting our guidance this year in U.S. thrombectomy and doing really well, the market penetration rate we have, the number of patients we will have helped is still really, really low penetration levels. We will have a long ways to go.

然後我們做出的下一個評論是關於我們的CAVT 產品和維持強勁增長，因為現實是，即使達到我們今年在美國血栓切除術的指導並且做得非常好，我們的市場滲透率，我們將擁有的患者數量有幫助的是滲透率仍然非常非常低。我們還有很長的路要走。

So that comment that I made right on the heels of making the comment about international was intended to talk about the fact that this is, as Adam has mentioned several times in the past, growth that can extend over the next ensuing years, a number of years. And so while I'm not going to quantify what we think 2025 looks like yet, we're pretty optimistic about 2024 and beyond.

因此，我在發表有關國際的評論之後發表的評論旨在談論這樣一個事實，即正如亞當過去多次提到的那樣，增長可以在接下來的幾年中延續，許多年。因此，雖然我還不打算量化我們對 2025 年的看法，但我們對 2024 年及以後的情況非常樂觀。

We'll go next to Mike Matson at Needham & Company.

接下來我們將前往 Needham & Company 的 Mike Matson。

I guess, first, with the efforts outside the U.S. to get the CAVT products on the market, I just want to understand -- I know it probably varies by country and whatnot, but it sounds like, generally, you feel like there's a need to get some reimbursement in place. Is it -- or is it just that there's reimbursement there and it's just not enough to cover the cost of the products?

我想，首先，隨著美國以外的國家努力將 CAVT 產品推向市場，我只是想了解 - 我知道這可能因國家/地區等因素而異，但聽起來，一般來說，您覺得有必要以獲得一些補償。是——還是只是有報銷，但不足以支付產品的成本？

Yes. Mike, that's a good question. We're talking about large geographies, many different countries in Europe that have different reimbursement schemes country by country, same in Latin America and Asia Pacific. So each one is obviously very different. There are going to be cases in which reimbursement is there for the most basic sort of catheter and syringe type system, which is not an expensive reimbursement. And then more sophisticated stuff is not yet reimbursed because they've never seen it. They don't know what it is. And we have to go through that effort. And then in other cases, there's really no reimbursement yet for that procedure at all. So it's a little of each. And obviously, we're focusing on some of the larger areas first, and then we'll continue to do that effort.

是的。麥克，這是個好問題。我們談論的是廣闊的地區，歐洲許多不同的國家都有不同的報銷計劃，拉丁美洲和亞太地區也是如此。所以每個人顯然都非常不同。在某些情況下，最基本的導管和注射器類型系統可以獲得報銷，這並不是昂貴的報銷。然後更複雜的東西還沒有得到報銷，因為他們從未見過它。他們不知道那是什麼。我們必須付出這樣的努力。而在其他情況下，該程式實際上根本沒有任何報銷。所以各有一點。顯然，我們首先關註一些更大的領域，然後我們將繼續努力。

Not different, just to give some context to what we did in stroke many, many years ago. Stroke was not reimbursed at all and ironically, still is not in certain countries, and we've been doing that work for the better part of almost 20 years now. So I think we know how to do it. It just takes time, and we want to do it right and make sure because we don't need to rush this because we have the benefit now of growth, particularly in the U.S.

沒什麼不同，只是為了給我們很多很多年前在中風方面所做的事情提供一些背景。中風根本沒有得到報銷，諷刺的是，在某些國家仍然沒有報銷，而我們在近 20 年的大部分時間裡一直在做這項工作。所以我想我們知道該怎麼做。這只是需要時間，我們希望做得正確並確保，因為我們不需要著急，因為我們現在受益於成長，特別是在美國。

Okay. Got it. And then just as far as the distributor ordering forecast or patterns you're expecting in 2024, I was wondering, in the commentary around exiting certain markets and certain product categories due to lower pricing, is China a factor in either of those things, either distributor ordering patterns or the markets you're exiting? Because I know there has been some VBP over there in the neurovascular area.

好的。知道了。然後，就您期望的 2024 年經銷商訂購預測或模式而言，我想知道，在有關因價格較低而退出某些市場和某些產品類別的評論中，中國是否是其中的一個因素分銷商訂購模式或您要退出的市場？因為我知道神經血管區域有一些 VBP。

Yes, Mike, that's a really important question. I'm glad you asked it. I just want to maybe remind you and everyone else that we have 3 different buckets of revenue from China. We have license fees, royalties and distribution. So that structure, as you know has sometimes created a funny quarter-by-quarter movement that we've talked about over the last couple of years in the past that on a longer-term basis, that same structure has provided us, I think, a lot of protection from some of the current climate in China.

是的，麥克，這是一個非常重要的問題。我很高興你問了這個問題。我只是想提醒您和其他所有人，我們來自中國的收入分為三個不同的部分。我們有許可費、特許權使用費和發行費。因此，正如您所知，這種結構有時會產生一種有趣的季度運動，我們在過去幾年中已經討論過，從長遠來看，我認為相同的結構為我們提供了，對中國當前的一些氣候有很大的保護。

So we feel pretty good about it. Going forward, we have a really incredible partner in Genesis. And we believe that our products, particularly the CAVT platform, can ultimately have an important place in the Chinese market. We've got a lot of work to do, but I think we're really set up for that, and we're pretty excited about it.

所以我們對此感覺很好。展望未來，我們在 Genesis 中擁有了一位非常出色的合作夥伴。我們相信我們的產品，特別是CAVT平台，最終能夠在中國市場佔有重要的一席之地。我們還有很多工作要做，但我認為我們已經為此做好了準備，而且我們對此感到非常興奮。

We'll take our final question today from Margaret Kaczor at William Blair.

今天我們將回答威廉布萊爾的瑪格麗特卡佐爾提出的最後一個問題。

This is Macauley on for Margaret. I appreciate you squeezing me in here. Just to kind of put 2 questions into one. I know you mentioned the 20% growth in U.S. stroke, large part of that obviously SENDit. But as we look towards 2024, do you expect SENDit to be able to bridge that gap within neuro? Or I guess how should we think about the rollout in terms of adoption compared to Flash and Bolt, which, to your point, might have a longer tailwind? And then to throw in the second, just any update in terms of THUNDER time line on the trial -- on the THUNDER trial?

這是瑪格麗特的麥考利。我很感激你把我擠在這裡。只是將兩個問題合而為一。我知道您提到美國中風發生率增加了 20%，其中很大一部分顯然是 SENDit。但當我們展望 2024 年時，您是否期望 SENDit 能夠彌合神經網路中的這一差距？或者我想我們應該如何考慮與 Flash 和 Bolt 相比，在採用方面的推出，在您看來，Flash 和 Bolt 可能有更長的推動力？然後再提出第二個問題，即有關 THUNDER 審判時間線的任何更新 - 關於 THUNDER 審判？

Yes. So let me -- I'll start with the last one. I've sort of answered that question around the Thunderbolt trial. It's going well. Enrollment continued. We aren't counting any of that revenue until 2026, so we've got a ways off, but the trial is going well.

是的。那麼讓我——我將從最後一個開始。我已經在 Thunderbolt 試驗中回答了這個問題。進行得順利。報名繼續進行。我們直到 2026 年才會計算任何收入，所以我們還有很長的路要走，但試驗進展順利。

So what we did is greater than 20%, not 20%. That business is really strong. And we don't yet have 100% of the market, and so we're going to continue to go after those physicians. Word of mouth is now really strong as people -- more and more physicians have used it and the platform to get to the place of clot, we're seeing more and more conversion to it. So yes, I think 2024 is going to be a good year for our stroke business, and we're going to continue to see some growth there.

所以我們做的是大於20%，而不是20%。這生意真是太強了。我們還沒有擁有 100% 的市場，所以我們將繼續追逐這些醫生。現在，隨著人們的口碑傳播，越來越多的醫生使用它和這個平台來治療血栓，我們看到越來越多的人轉向它。所以，是的，我認為 2024 年對於我們的中風業務來說將是美好的一年，我們將繼續看到一些成長。

Obviously, that will continue and get even more when Thunderbolt comes. But in the meantime, it stands as an anticipation of Thunderbolt because, again, you've got to have the catheter there first. Then, you can use Thunderbolt. So the setup is really kind of perfect for us.

顯然，當 Thunderbolt 到來時，這種情況將會持續下去，甚至會變得更加嚴重。但同時，它也是對 Thunderbolt 的期待，因為你必須先在那裡放置導管。然後，您可以使用迅雷。所以這個設置對我們來說真的很完美。

And that does conclude the question-and-answer session. I'll turn the conference back over to Ms. Hamlyn-Harris.

問答環節到此結束。我將把會議轉回給哈姆林-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 first 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。我們期待在第一季電話會議上向您通報最新情況。

And this concludes today's conference call. Thank you for your participation. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。