Penumbra Inc (PEN) 2024 Q1 法說會逐字稿

Good afternoon. My name is Ellie, and I will be your conference operator for today. At this time, I would like to welcome everyone to Penumbra's First Quarter 2024 Conference Call. (Operator Instructions) I would like to introduce Ms. Cecilia Furlong, Business Development and Investor Relations for Penumbra. Ms. Furlong, you may now begin your conference.

午安.我叫艾莉，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 2024 年第一季電話會議。 （操作員說明） 我想介紹一下 Penumbra 業務開發和投資者關係部門的 Cecilia Furlong 女士。弗隆女士，您現在可以開始會議了。

Thank you, operator, and thank you all for joining us on today's call to discuss Penumbra's earnings release for the first quarter of 2024. 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. 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, filed with the SEC.

感謝營運商，感謝大家參加今天的電話會議，討論 Penumbra 2024 年第一季度的收益發布。的“投資者”選項卡下。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、合規性的聲明和商業趨勢。由於某些風險和不確定性，包括我們向SEC 提交的截至2023 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, financial results for revenue and gross margin are presented on a GAAP basis, while operating expenses, operating income and adjusted EBITDA 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 and operating income exclude amortization of acquired intangible assets of $2.4 million in the first quarter of 2024 and 2023 and $4.8 million of nonrecurring litigation-related expenses, including settlement costs and legal fees associated with wage and hour complaints filed against the company in 2023 in the first quarter of 2024. And adjusted EBITDA excludes such nonrecurring litigation-related expenses and stock compensation expense. 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 first quarter of 2024, and Jason Mills, our Executive Vice President of Strategy, will discuss our 2024 guidance. With that, I would like to turn the call over to Adam Elsesser.

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，收入和毛利率的財務表現按照公認會計原則（GAAP）計算，而營運費用、營運收入和調整後的 EBITDA 則按照非公認會計原則（Non-GAAP）計算。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和營運收入不包括2024 年第一季和2023 年第一季收購的無形資產攤銷240 萬美元，以及480 萬美元的非經常性訴訟相關費用，包括與針對公司提出的工資和工時投訴相關的和解費用和法律費用。 Penumbra 董事長兼執行長 Adam Elsesser 將提供業務最新動態。然後，我們的財務長 Maggie Yuen 將討論我們 2024 年第一季的財務業績，我們的策略執行副總裁 Jason Mills 將討論我們的 2024 年指引。說到這裡，我想將電話轉給 Adam Elsesser。

Thank you, Cecilia. Good afternoon. Thank you for joining Penumbra's First Quarter 2024 Conference Call. Our total revenues for the first quarter were $278.7 million, a year-over-year increase of 15.4% is reported and 15.2% on a constant currency basis. Our U.S. thrombectomy revenue grew 35.2% compared to the same quarter a year ago to $150.3 million, driven by continued strong market growth and share gain with Lightning Flash and Lightning Bolt 7. International thrombectomy also exceeded our expectations in the first quarter, growing 10.7% year-over-year against the challenging comparison last year. Overall, we had a strong start to the year and see positive trends in our core markets and our business with our computer-assisted vacuum thrombectomy products in VTE and arterial, and market-leading portfolio in stroke. This reinforces our confidence we can deliver strong growth of 27% to 30% in U.S. thrombectomy and 16% to 20% overall in 2024.

謝謝你，塞西莉亞。午安.感謝您參加 Penumbra 2024 年第一季電話會議。我們第一季的總營收為 2.787 億美元，年增 15.4%，以固定匯率計算成長 15.2%。受持續強勁的市場成長以及Lightning Flash 和Lightning Bolt 7 份額成長的推動，我們的美國血栓切除術收入較去年同期增長35.2%，達到1.503 億美元。 ，成長了10.7%與去年的挑戰性比較相比。總體而言，我們今年取得了良好的開局，並看到我們的核心市場和我們的業務呈現出積極的趨勢，包括靜脈血栓栓塞和動脈電腦輔助真空血栓切除術產品以及市場領先的中風產品組合。這增強了我們的信心，我們可以在 2024 年實現美國血栓切除術強勁增長 27% 至 30%，整體成長 16% 至 20%。

In addition to our commitment to strong revenue growth, we are also focused on margin expansion and increasing profitability. We are ahead of schedule to deliver 100 to 150 basis points of gross margin expansion in 2024 and are confident we can increase our gross margins to more than 70% within the next 24 to 30 months. We are also on track to deliver at least 100 to 200 basis points of operating margin expansion this year, inclusive of investments we are making in our U.S. commercial team and market access initiatives, both of which should help us sustain strong growth into the future. Operating income in the first quarter was $19.3 million, representing 6.9% of revenue, increasing 260 basis points over the same period a year ago. Looking forward, we expect our operating margin expansion to outpace gross margin expansion for the foreseeable future. Notwithstanding the strong growth we have seen in U.S. thrombectomy over the past few years, clinically significant clot burden is still one of the most undertreated acute issues in health care today. We are well positioned to expand access to CAVT, and make the treatment of these patients safer, simpler and faster, which we strongly believe and are committed to continually prove accrues to the benefit of patients, physicians and hospital systems.

除了致力於強勁的收入成長之外，我們還專注於利潤率擴張和獲利能力的提高。我們提前實現 2024 年毛利率擴張 100 至 150 個基點，並有信心在未來 24 至 30 個月內將毛利率提高至 70% 以上。我們今年還有望實現至少 100 至 200 個基點的營業利潤率擴張，其中包括我們對美國商業團隊的投資和市場准入計劃，這兩者都將有助於我們在未來保持強勁增長。第一季營業收入為1,930萬美元，佔營收的6.9%，比去年同期成長260個基點。展望未來，我們預計在可預見的未來，我們的營業利潤率擴張將超過毛利率擴張。儘管我們在過去幾年中看到美國血栓切除術的強勁增長，但臨床上顯著的血栓負擔仍然是當今醫療保健中治療最不足的急性問題之一。我們有能力擴大 CAVT 的覆蓋範圍，使這些患者的治療更安全、更簡單、更快捷，我們堅信並致力於不斷證明這對患者、醫生和醫院系統有利。

Over the past several quarters, we have delineated our strategy to deliver outsized revenue growth in thrombectomy over the near-, medium and long-term through a combination of continued innovation with our CAVT platform, optimizing our commercial team in both the U.S. and international markets and developing robust clinical and health economic evidence on our CAVT products. With this collective work, we are confident we will continue to catalyze adoption of CAVT and drive utilization to the majority of the 1.25 million applicable clot patients in the United States each year across the 5 vascular beds we address today. We fully launched Lightning Flash 2.0 in late April on the heels of outstanding outcomes from the valuation cases done in early April.

在過去的幾個季度中，我們制定了策略，透過持續創新與 CAVT 平台相結合，優化我們在美國和國際市場的商業團隊，在近期、中期和長期內實現血栓切除術收入的大幅增長並為我們的CAVT 產品開發可靠的臨床和健康經濟證據。透過這項集體工作，我們相信我們將繼續促進 CAVT 的採用，並在我們今天討論的 5 個血管床中推動美國每年 125 萬適用血栓患者中的大多數患者的利用。繼4月初完成的估值案例取得優異成果後，我們於4月下旬全面推出了Lightning Flash 2.0。

Flash 2.0 is proving in practice what we saw on the bench. The product further optimizes the advantages of CAVT and VTE. We are seeing pent-up demand for Flash 2.0, and coupled with the larger commercial team we've developed over the past 2 quarters, our U.S. thrombectomy business is in a strong position to continue to catalyze growth for us in these markets in this year and beyond. We're also seeing meaningful progress within our innovation pipeline and are on track to launch three additional CVT products within the next 12 months, at least one of which we expect before the end of 2024.

Flash 2.0 正在實踐中證明我們在板凳上看到的東西。本產品進一步優化了CAVT和VTE的優勢。我們看到了對 Flash 2.0 的被壓抑的需求，再加上我們在過去兩個季度建立的更大的商業團隊，我們的美國血栓切除業務今年處於有利地位，可以繼續促進我們在這些市場的成長超越。我們也看到我們的創新管道取得了有意義的進展，並預計在未來 12 個月內推出另外三款 CVT 產品，我們預計至少其中一款會在 2024 年底之前推出。

Overall, we are committed to continued innovation to augment the utility and reach of CAVT head to toe. In addition to VTE and arterial, stroke will be the next vascular bed we address with CAVT. Enrollment in our THUNDER study is going very well, and we are very encouraged by outcomes and physician engagement. We now hold nearly 60% market share in the U.S. stroke market and expect to gain more share through 2024, ahead of a Thunderbolt launch, which will further extend our leadership position. We are also seeing more energy and engagement from large health care systems seeking to work with us as the industry leader on ways to further extend interventional stroke care to many more patients within their networks. Our proprietary technology portfolio in stroke, our reputation in the field and our scale gives us the unique ability to do this work with health care systems going forward. I'll now turn the call over to Maggie to go over our financial results for the first quarter of 2024.

整體而言，我們致力於持續創新，從頭到腳增強 CAVT 的實用性和覆蓋範圍。除了 VTE 和動脈之外，中風將是我們透過 CAVT 解決的下一個血管床問題。我們的 THUNDER 研究的招募進展順利，我們對結果和醫生的參與感到非常鼓舞。目前，我們在美國中風市場佔有近 60% 的市場份額，預計到 2024 年，在 Thunderbolt 推出之前，我們將獲得更多份額，這將進一步鞏固我們的領導地位。我們也看到大型醫療保健系統投入了更多的精力和參與，尋求與我們作為行業領導者合作，進一步將介入性中風護理擴展到其網路內的更多患者。我們在中風領域的專有技術組合、我們在該領域的聲譽和規模使我們擁有獨特的能力，能夠在未來的醫療保健系統中進行這項工作。我現在將電話轉給 Maggie，討論我們 2024 年第一季的財務業績。

Thank you, Adam. Good afternoon, everyone. Today, I will discuss the financial results for the first quarter of 2024. As a reminder, financial results on this call for revenue and gross margin are on a GAAP basis, while operating expenses, operating income and adjusted EBITDA 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. For the first quarter ended March 31, 2024, our total revenues were $278.7 million, an increase of 15.4% reported and 15.2% in constant currency compared to the first quarter of 2023. Our geographic mix of sales for the first quarter 2024 was 75.2% U.S., and 24.8% international. Our U.S. reported growth of 22%, driven by 35.2% growth in our thrombectomy franchise. Our international regions declined a modest 0.7%, reflecting a decline in our overall embolization and access product revenue, offset by growth in thrombectomy (inaudible) in Europe, APAC, Canada and Latin America.

謝謝你，亞當。大家下午好。今天，我將討論2024 年第一季的財務表現。 GAAP 基礎上的基礎。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。截至2024 年3 月31 日的第一季度，我們的總營收為2.787 億美元，與2023 年第一季相比，報告成長15.4%，以固定匯率計算成長15.2%。銷售地理組合為75.2%美國，24.8% 國際。在我們的血栓切除術業務成長 35.2% 的推動下，我們的美國業務成長了 22%。我們的國際區域小幅下降 0.7%，反映出我們整體栓塞和通路產品收入的下降，但被歐洲、亞太地區、加拿大和拉丁美洲血栓切除術（聽不清楚）的成長所抵消。

Moving to revenue by products. Revenue from global thrombectomy business grew to $187.7 million in the first quarter of 2024, an increase of 29.5% reported and 29.3% in constant currency compared to the same period last year. Our U.S. growth of 35.2% and international growth of 10.7% compared to the same period last year reflects strong momentum in CAVT products. Revenue from our embolization and access business was $91 million in the first quarter of 2024, a decline of 5.7% reported and 6% in constant currency, primarily driven by an overall decline in international markets. Turning to gross margin. Gross margin for the first quarter of 2024 was 65% compared to 62.6% for the first quarter of 2023. We delivered 240 basis point improvement, driven by favorable thrombectomy product mix across all regions and strong productivity, partially offset by material cost increases and investment in direct labor capacity for new product launches and higher demand. We are on track to deliver 100 to 150 basis point gross margin expansion in 2024.

轉向按產品劃分的收入。 2024 年第一季度，全球血栓切除業務收入成長至 1.877 億美元，與去年同期相比成長 29.5%，以固定匯率計算成長 29.3%。與去年同期相比，我們的美國成長 35.2%，國際成長 10.7%，反映出 CAVT 產品的強勁勢頭。 2024 年第一季度，我們的栓塞和通路業務收入為 9,100 萬美元，報告下降 5.7%，以固定匯率計算下降 6%，這主要是由於國際市場整體下滑所致。轉向毛利率。 2024 年第一季的毛利率為65%，而2023 年第一季為62.6%。被材料成本增加和投資所抵消新產品發布和更高需求的直接勞動力能力。我們預計在 2024 年實現 100 至 150 個基點的毛利率擴張。

Now on to our non-GAAP operating expenses, non-GAAP operating income and margin, and adjusted EBITDA. Total operating expense for the quarter was $161.8 million or 58.1% of revenue compared to $170.7 million(sic) [$140.7 million] or 58.3% of revenue for the same quarter last year. Our research and development expenses for Q1 2024 were $24.6 million compared to $20 million for Q1 2023. SG&A expenses for Q1 2024 were $137.2 million(sic) [$144.4 million] or 49.2% of revenue compared to $120.7 million(sic) [$123.1 million] or 50% of revenue for Q1 2023. With higher seasonality expenditures in the first quarter, we expect continued leverage in our SG&A expenditures as a percentage of revenue. We recorded operating income of $19.3 million or 6.9% of revenue in the first quarter of 2024. The compared to an operating income of $10.4 million or 4.3% of revenue for the same period last year. We expect to continue operating margin improvement of 100 to 200 basis points throughout 2024. We posted adjusted EBITDA of $37.6 million or 13.5% of total revenue compared to 11.4% in the first quarter last year. Turning to cash flow and balance sheet. We ended the first quarter with cash, cash equivalents and marketable security balance of $313.5 million and no debt, an increase of $24.3 million driven by operating profitability and improvements in working capital turns. We expect positive operating cash flow trends to continue in 2024. And now I'd like to turn the call over to Jason to discuss our guidance.

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 1.618 億美元，佔營收的 58.1%，去年同期為 1.707 億美元（原文如此）[1.407 億美元]，佔營收的 58.3%。我們2024 年第一季的研發費用為2,460 萬美元，而2023 年第一季為2,000 萬美元。營收的49.2%，而2024 年第一季的SG&A 費用為1.207 億美元（原文如此）[1.231 億美元]或2023 年第一季營收的50%。 SG&A 支出佔收入的百分比將繼續發揮槓桿作用。 2024 年第一季度，我們的營業收入為 1,930 萬美元，佔營收的 6.9%。我們預計 2024 年營業利潤率將繼續提高 100 至 200 個基點。轉向現金流和資產負債表。第一季結束時，我們的現金、現金等價物和有價證券餘額為 3.135 億美元，無債務，由於營業利潤和營運資金周轉率的改善，增加了 2,430 萬美元。我們預計積極的營運現金流趨勢將在 2024 年持續下去。

Thank you, Maggie, and good afternoon, everybody. Strong trends in our U.S. thrombectomy franchise through the first quarter, the recent launch of Lightning Flash 2.0 in the United States, and continued productivity momentum from our expanded U.S. commercial team reinforced our expectation for strong U.S. thrombectomy and total revenue growth of 27% to 30% and 16% to 20%, respectively, for full year 2024. Consistent with the cadence commentary we provided on our earnings call in February, we expect global revenue growth in the first half of the year to be in the mid-teens range, primarily based on currently forecasted orders from our international distributors and timing of new product launches. We then expect growth to accelerate to the high end of our 16% to 20% guidance range or above in the second half of the year. We continue to expect growth in U.S. thrombectomy to be consistently strong in our guidance range throughout the year, and we now expect growth from our international thrombectomy franchise to be slightly stronger than we conveyed on our last earnings call, mid- to high-single-digit range for full year 2024, compared to flat to modest growth conveyed on our last call. For our embolization and access business for the full year, we expect mid-single-digit growth in the U.S. and flat internationally. That said, we expect year-over-year growth rates for both U.S. and international embolization and access businesses to strengthen throughout the year to the low teens range by the fourth quarter from new product launches and increasing productivity from our larger commercial team. Lastly, we continue to expect strong expansion in both gross margin and operating margin in 2024. We reiterate our guidance for 100 to 150 basis point expansion in gross margin and 100 to 200 basis points expansion in operating margins each quarter on a year-over-year basis as well as for the full year. Operator, we can now open the call to questions.

謝謝瑪吉，大家下午好。第一季我們美國血栓切除術業務的強勁趨勢、最近在美國推出的Lightning Flash 2.0 以及我們擴大的美國商業團隊持續的生產力動力增強了我們對美國血栓切除術強勁和總收入增長27% 至30%的預期2024 年全年分別成長 % 和 16% 至 20%。我們國際分銷商目前預測的訂單和新產品發布的時間。然後，我們預計下半年成長將加速至 16% 至 20% 指導範圍的高端或更高。我們仍然預計美國血栓切除術的增長將在全年的指導範圍內持續強勁，並且我們現在預計我們的國際血栓切除術專營權的增長將略強於我們在上次財報電話會議上傳達的中高單-與我們上次電話會議中傳達的持平至溫和增長相比，2024 年全年的數字範圍。對於我們全年的栓塞和通路業務，我們預計美國將實現中個位數成長，而國際市場則持平。也就是說，我們預計，由於新產品的推出和我們更大的商業團隊生產力的提高，美國和國際栓塞和通路業務的全年成長率將在第四季度加強到十幾歲以下。最後，我們繼續預期 2024 年毛利率和營業利潤率將強勁增長。基礎，也以全年為基礎。接線員，我們現在可以開始提問。

(Operator Instructions) Your first question comes from Margaret Kaczor from William Blair.

（操作員說明）您的第一個問題來自威廉布萊爾的瑪格麗特卡佐爾。

Yes, I maybe wanted to ask first just on some of the comments around optimizing the sales team in both the U.S./no U.S., obviously thrombectomy growth in both markets, seems like it's picking up nicely and maybe a little bit stronger, frankly, than what we experienced. So how much of it is that -- How much of it is it around current market growth and some of the continuation of what you saw last year? And specifically, what metrics are you focused on with regards to those investments? Is it geographies? Is it certain market access? Where are you focused on?

是的，我可能想先詢問有關優化美國/非美國銷售團隊的一些評論，顯然，這兩個市場的血栓切除術增長似乎都在很好地增長，坦率地說，可能比我們經歷了什麼。那麼，其中有多少是——有多少是圍繞當前市場成長以及去年看到的一些延續？具體來說，您關注這些投資的哪些指標？是地理嗎？是否有一定的市場進入？你的注意力集中在哪裡？

It's a great series of questions, Margaret. Let me try to break it down and remind everyone, philosophically, we typically hire behind our growth, not ahead of our growth, and I think people have known that. And so we were looking at last year with a huge demand for the new CAVT platform. And we just didn't have enough people, and we brought them on late in the year, got them up and going, added some more in the first quarter. So we -- the -- this quarter wasn't really the product of a lot of the new people. They're now in place going forward for the second, third and fourth quarter. And so what really is driving the growth in the first quarter is really just the work that we laid out all of last year around both Lightning Flash and Lightning Bolt and how good they are and how many people are experiencing them and trying them and continuing to do it. Obviously, we talked about April being the quarter that we started to do Flash 2.0 cases. So that's not in the first quarter number, that's yet to come, obviously.

這是一系列很棒的問題，瑪格麗特。讓我嘗試將其分解並提醒大家，從哲學上講，我們通常在我們的成長之後進行招聘，而不是在我們的成長之前進行招聘，我認為人們已經知道這一點。因此，我們去年看到了對新 CAVT 平台的巨大需求。我們只是沒有足夠的人員，我們在今年晚些時候引進了他們，讓他們開始工作，並在第一季增加了更多人。所以我們這個季度並不是很多新人的產物。他們現在已經就位，準備迎接第二、第三和第四季。因此，真正推動第一季成長的實際上只是我們去年全年圍繞 Lightning Flash 和 Lightning Bolt 所做的工作，以及它們有多好，以及有多少人正在體驗它們、嘗試它們並繼續使用它們。 。顯然，我們談到四月是我們開始做Flash 2.0案例的季度。所以這不在第一季的數字中，顯然還沒到來。

Okay. And as it relates to guidance, obviously, a great quarter again. So I'll push on that a little bit more, especially for U.S. thrombectomy. You're on the high end of the range, obviously, an easier comp in the first quarter. So I get that from that perspective. But on the same token, you have these commercial investments that you're making that should ramp up. You're also -- we're going to see some data that maybe helps the entire market grow a little bit as we go on throughout the year. Why shouldn't we continue to expect things there, if not even accelerating a little bit?

好的。顯然，就指導而言，這又是一個偉大的季度。所以我會進一步推動這一點，特別是對於美國的血栓切除術。顯然，你處於範圍的高端，第一季的比賽比較容易。所以我從這個角度來理解這一點。但出於同樣的原因，您正在進行的這些商業投資應該會增加。我們還將看到一些數據，這些數據可能有助於整個市場在全年中成長。為什麼我們不應該繼續期待那裡的事情，即使不是加速一點點呢？

Yes, Margaret, it's a great question. As our current guidance obviously reflects already a faster growth as the year progresses. We've taken that into account in this quarter's strong start reinforces our confidence in our business. And our guidance, in particular our U.S. thrombectomy guidance for the full year reflects both that strength and the momentum from our products and our commercial team. So I think we're in pretty good shape as we think about how the year unfolds.

是的，瑪格麗特，這是一個很好的問題。我們目前的指導顯然反映出隨著時間的推移已經有了更快的成長。我們考慮到這一點，本季的強勁開局增強了我們對業務的信心。我們的指導，特別是我們全年的美國血栓切除術指導，反映了我們的產品和商業團隊的實力和動力。因此，我認為，當我們思考這一年的發展時，我們的狀態非常好。

The next question comes from Joanne Wuensch from Citi.

下一個問題來自花旗銀行的 Joanne Wuensch。

Two questions really. OUS sales look like they are improving or expected to improve throughout the year? Could you please sort of remind us why that may be? And then my second question has to do with margins. It sounds like you have a little bit more of an increased focus on gross and operating margins? And can you please outline not just gross margin, but throughout the income statement, what levers do you have to pull to get there?

確實有兩個問題。 OUS 的銷售額看起來正在改善或預計全年都會改善？您能提醒我們為什麼會這樣嗎？我的第二個問題與利潤有關。聽起來您似乎更關注毛利率和營業利潤率？您能否不僅概述毛利率，而且在整個損益表中概述您必須採取哪些槓桿才能實現這一目標？

Yes. Margaret -- Joanne, I'm sorry, it's Jason. I'll take the first one and then Maggie and Adam can take the second one, if that's okay. The international cadence typically does escalate as the year goes on. We also have, in Europe, taking that, for example, our newest red stroke products are just being launched there. And so you can imagine the cadence of that will -- we expect to improve. And then in the second half of the year, we think in Europe, they're going to get the new CAVT portfolio. In addition to that, around the world, the timing of international orders, as we've talked about, we have pretty good visibility into. So that's why the guidance -- the comprehensive guidance sort of reflects that cadence for total revenue throughout the year. Maggie?

是的。瑪格麗特——喬安妮，對不起，我是傑森。我會選擇第一個，然後瑪姬和亞當可以選擇第二個，如果可以的話。隨著時間的推移，國際節奏通常會逐漸升級。例如，我們在歐洲也剛推出了我們最新的紅色中風產品。所以你可以想像這種節奏——我們希望能夠改進。然後在今年下半年，我們認為在歐洲，他們將獲得新的 CAVT 產品組合。除此之外，正如我們所討論的，在世界各地，我們對國際訂單的時間表有很好的了解。這就是為什麼指導——綜合指導反映了全年總收入的節奏。劣質煤？

Yes. And in terms of our operating margin focus, I mean, in addition to the product mix improvement that you see in gross margin on the operating side, a lot of the G&A infrastructure investment that we made in the last couple of years, will continue to see scalability and, frankly, across all SG&A areas.

是的。就我們對營運利潤率的關注而言，我的意思是，除了您在營運方面的毛利率中看到的產品組合改善之外，我們在過去幾年中進行的大量一般管理基礎設施投資將繼續坦白說，了解所有SG&A 領域的可擴展性。

Our next question comes from Bill Plovanic from Canaccord Genuity Fund.

我們的下一個問題來自 Canaccord Genuity Fund 的 Bill Plovanic。

So, just on the U.S. thrombectomy market, it seems we get a lot of questions on this, obviously, a big driver for you. I was wondering if you could help just parse out how much of that growth is VTE versus arterial. And then how much of this is ASP versus just pure volume driven? Because my understanding is you have been getting an ASP boost over the last year. I'm just trying to understand just a little more granularity, if we could.

因此，就美國血栓切除術市場而言，我們似乎收到了很多關於這方面的問題，顯然，這對您來說是一個很大的推動力。我想知道您是否可以幫忙分析一下，靜脈血栓栓塞（VTE）與動脈血管的增長有多少。那麼，其中有多少是由 ASP 驅動的，而不是純粹由銷售驅動的？因為我的理解是，去年您的平均售價有所提升。如果可以的話，我只是想更詳細地了解一下。

Yes. I think it's a great question. Let me try to give some color to it. Obviously, our CAVT products drove most of that growth, with Flash continuing to take share and catalyze new adoption. Bolt also continued to perform well on the arterial side. Also, our stroke business had really strong growth sort of within our guidance range that we've given as stroke continues to see significant gains, and we expect that to continue. If I would sort of think about it, last year, there was some mix between price and volume, obviously. But now we're anniversarying that. That happened -- we launched Flash at the end of -- the beginning of last 2023. So almost all of this is new business and price isn't really reflective in the growth number. It's really business, both as the market continues to grow and we catalyze adoption and, of course, some share gain.

是的。我認為這是一個很好的問題。讓我嘗試給它一些色彩。顯然，我們的 CAVT 產品推動了大部分成長，而 Flash 繼續佔據份額並促進新的採用。博爾特在動脈方面也繼續表現出色。此外，我們的中風業務在我們給出的指導範圍內確實實現了強勁增長，因為中風業務繼續取得顯著增長，我們預計這種情況將持續下去。如果我想一想，去年的價格和數量之間顯然存在一些混合。但現在我們正在慶祝這一周年。那件事發生了——我們在 2023 年底——年初推出了 Flash。這確實是生意，因為市場不斷成長，我們促進採用，當然還有一些份額的成長。

Great. And if I could, just on the litigation expense, $4.8 million, you backed it out. Just kind of curious what that was. Is it onetime in nature? Or is that going to occur for a couple of more quarters? I don't know if it's ongoing litigation. Just any help for us to understand and how we should be thinking about that.

偉大的。如果可以的話，僅用 480 萬美元的訴訟費用，你就支持了。只是有點好奇是什麼。自然界是一次性的嗎？或者這種情況還會持續幾個季度？不知道訴訟是否還在進行中。只是幫助我們理解以及我們應該如何思考這一點。

Sure. It's a great question. As you know, we manufacture all of our products here in California. California, like every state has wage and hour laws. California has an additional aspect of a private attorney general action, which sometimes can make those complicated. We believe very strongly that we have run and follow the rules. There were some technical violations and we settled those claims pretty quickly for a scale, this is a onetime settlement this captures it all, and we can move on to making our products and doing the things that matter the most.

當然。這是一個很好的問題。如您所知，我們所有的產品均在加利福尼亞州生產。與每個州一樣，加州也有工資和工時法律。加州還有私人總檢察長訴訟的另一個方面，這有時會使事情變得複雜。我們堅信我們已經運作並遵守規則。存在一些技術違規行為，我們很快就大規模解決了這些索賠，這是一個解決方案，涵蓋了所有問題，我們可以繼續製造我們的產品並做最重要的事情。

Next question comes from Robbie Marcus from JPMorgan.

下一個問題來自摩根大通的羅比·馬庫斯。

Maybe just to start, really good growth in thrombectomy in the quarter. Access and Embo was weaker. Maybe you could just talk to the trends you're seeing? How much is stocking, destocking versus underlying trends? And how to think about some of the nuances between the different products there moving forward?

也許只是開始，本季血栓切除術確實出現了良好的成長。 Access 和 Embo 較弱。也許您可以談談您所看到的趨勢？庫存、去庫存與基本趨勢相比有多少？如何思考未來不同產品之間的一些細微差別？

Yes. Robbie, it's Adam. I appreciate very much the question. Obviously, as you know, we broke out the numbers differently, so people could sort of accurately view what I think everyone agrees is what's driving our growth and what's valuing the business. Obviously, you know that in the U.S., our -- we have market-leading products in both peripheral embo and neuroaxis. And that business is something we're particularly proud of. But we've said, obviously, that what's driving our growth is going to be the thrombectomy. That's where our focus is going to be moving forward. In addition, on the call in Q4, we specifically called out that we would be leaving certain markets with our embo and access business in international markets where they weren't financially viable for us as product reimbursements changed and moved down over time. So we sort of said that going forward. That's what happened. We also are particularly proud of the way the thrombectomy business has gone. And remember, in Jason's prepared remarks just today, we did say that we'll expect to see growth in our U.S. embo and access business as the year progresses and we move with our new larger commercial teams on the thrombectomy side, we'll have the scale and the capacity to focus on multiple things as well as some new launches. We just had one with Midway, which is a neuro access tool at the beginning of this quarter. So the business is strong. It's just not going to be the thing that drives the growth in an outsized way like our thrombectomy business will.

是的。羅比，我是亞當。我非常感謝這個問題。顯然，如您所知，我們以不同的方式列出了這些數字，因此人們可以準確地了解我認為每個人都同意的推動我們成長的因素以及對業務估值的因素。顯然，你知道在美國，我們在周邊栓塞和神經軸方面擁有市場領先的產品。這項業務是我們特別引以為傲的。但我們已經說過，顯然，推動我們成長的將是血栓切除術。這就是我們前進的重點。此外，在第四季度的電話會議上，我們特別指出，我們將在國際市場上保留某些市場的嵌入和准入業務，這些市場對我們來說在財務上不可行，因為產品報銷隨著時間的推移而變化和下降。所以我們就這麼說了。這就是發生的事情。我們也對血栓切除術業務的發展方式感到特別自豪。請記住，在傑森今天準備好的講話中，我們確實說過，隨著時間的推移，我們預計美國的血栓和通路業務將會增長，並且我們將在血栓切除術方面與我們新的更大的商業團隊一起行動，我們將專注於多種事物以及一些新產品的規模和能力。我們剛剛與 Midway 合作，這是本季初的神經存取工具。所以生意很強勁。它不會像我們的血栓切除業務那樣以巨大的方式推動成長。

Great. Maybe just one extra. As we think about now U.S. thrombectomy and OUS thrombectomy, which, like I said, had really good quarters, how do we think about some of the underlying trends in neuro versus peripheral? And is there any way to size the two?

偉大的。也許只是多了一件。當我們現在思考美國血栓切除術和 OUS 血栓切除術時，正如我所說，它們的季度業績非常好，我們如何看待神經與週邊血管的一些潛在趨勢？有什麼辦法可以調整兩者的大小嗎？

You're talking about within the various vascular beds in thrombectomy. Yes, obviously, if you look at our U.S. numbers, the bigger growth came from VTE on the veinous side with Flash. Obviously, now with launch of 2.0, that will continue as the market grows and we catalyze adoption and, of course, take share with that. The arterial side is continuing to also do well. And stroke did really, really well. We were pleasantly surprised. I think I answered another question earlier just now that our stroke growth was sort of within our range that we put out there, which is pretty significant now having multiple quarters where the stroke business has continued to grow. Some of that is market, a lot of that still share. And I think that will continue as a nice setup as people get more and more excited about Thunderbolt.

您談論的是血栓切除術中的各種血管床。是的，顯然，如果你看一下我們美國的數據，你會發現更大的增長來自 VTE 與 Flash 的靜脈側。顯然，現在隨著 2.0 的推出，隨著市場的成長，這種情況將繼續下去，我們將促進採用，當然，也會從中分享。動脈側也繼續表現良好。中風確實非常非常好。我們感到驚喜。我想我剛才回答了另一個問題，即我們的中風成長在我們提出的範圍之內，這非常重要，因為中風業務在多個季度都在持續成長。其中一些是市場，其中許多仍然是份額。我認為隨著人們對 Thunderbolt 越來越感興趣，這將繼續成為一個很好的設定。

Next question comes from Larry Biegelsenn from Wells Fargo.

下一個問題來自富國銀行的 Larry Biegelsenn。

So Adam, you're counting on international sales of peripheral devices to drive growth next year. And the issue has been, internationally, reimbursement. So what proof points can you provide that give us confidence that the reimbursement will be in place next year to drive that revenue?

Adam，您指望週邊設備的國際銷售來推動明年的成長。在國際上，問題一直是報銷。那麼，您能提供哪些證據來讓我們相信明年將進行報銷以推動收入成長呢？

Yes. I appreciate the question. Let me -- if I -- without being inappropriate, I -- we're not counting on international to drive our growth. I think I've tried to say over and over that our U.S. thrombectomy business is what is going to drive our growth. I think I even said it just in the last question. So that is what is going to drive our growth, not just this year, but for many, many years, as we continue to catalyze the adoption of that. The conversations we're having, the reaction we're having not just with physicians, but in a larger context is very, very encouraging. International adds to that, but it is not the centerpiece of our growth going forward. And obviously, it will be slightly -- I won't say -- slower is the wrong term, but it will be less all at once because of what you just said, certain markets, certain countries will have reimbursement already in place. Some systems have a difference between private and public, where we can start to go on the private side, but public won't come as fast. All of that's taken into account as we look out in the future. But I think we have many, many years of growth being driven in our U.S. thrombectomy business.

是的。我很欣賞這個問題。讓我——如果我——沒有不當的話，我——我們不指望國際來推動我們的成長。我想我已經一遍又一遍地說過，我們的美國血栓切除業務將推動我們的成長。我想我甚至在最後一個問題中就說過了。因此，這將推動我們的成長，不僅是今年，而且是很多年，因為我們將繼續推動這一點的採用。我們不僅與醫生進行的對話和反應，而且在更大的範圍內都非常非常令人鼓舞。國際化對此有所補充，但它並不是我們未來成長的核心。顯然，它會稍微——我不會說——慢一些，這是錯誤的術語，但它會一下子減少，因為你剛才所說的，某些市場、某些國家已經有了報銷。有些系統有私有和公共的區別，我們可以從私有方面開始，但公共方面不會那麼快。當我們展望未來時，所有這些都會被考慮在內。但我認為我們的美國血栓切除術業務多年來一直在推動成長。

Okay. That's helpful. Just for my follow-up, Adam, on Thunder, the comments you made on enrollment and encouraging outcomes, I think you said. What's the latest on when you expect to complete enrollment? Is clintrials.gov accurate, which says, I think, primary endpoint completion? I think, last time I looked March 2025.

好的。這很有幫助。亞當，關於雷霆的後續行動，你對入學和令人鼓舞的結果發表的評論，我想你說過。您預計何時完成註冊，最新進展如何？我認為 clintrials.gov 所說的主要終點完成情況是否準確？我想，我上次看是在 2025 年 3 月。

Well, Larry, I think you know that I've learned my lesson to be too predictive particularly on this trial. So we'll leave the -- were clinicaltrials.gov is right now. Needless to say, obviously, we're excited about it. It's progressing. We've seen a lot of engagement, a lot of discussion and excitement about it. And so I think we'll leave the exact timing the way it is for now.

好吧，拉里，我想你知道我已經吸取了教訓，不要過於預測，特別是在這次審判中。因此，我們將離開—clinicaltrials.gov 現在的狀態。不用說，顯然我們對此感到興奮。它正在進步。我們看到了很多參與、很多討論和對此感到興奮。所以我認為我們暫時保留確切的時間安排。

Our next question comes from Matthew O'Brien from Piper Sandler.

我們的下一個問題來自 Piper Sandler 的 Matthew O'Brien。

Just looking at how the stock is trading in the aftermarket down a little bit. I'm assuming that most people are thinking that the guide for the rest of the year might be a little bit at risk just given tougher comps, but it does look like the thrombectomy business is accelerating on a 2-year stack basis. Even the embo and access in the U.S. seems like it's pretty good. So just the combination of what you're seeing from a new customer perspective, going deeper in existing accounts? And then this expanded sales force, those folks don't kick in right away. It typically takes a little bit of time. So just the combination of all those things, can you just give us a sense for what you're really counting on to see this acceleration in the back half as -- or sorry, the last 3 quarters of the year as comps get tougher in the U.S. business?

只要看看股票在售後市場的交易情況如何，就會略有下跌。我假設大多數人都認為，考慮到更嚴格的競爭，今年剩餘時間的指南可能會有點危險，但看起來血栓切除術業務確實在兩年堆疊的基礎上加速成長。就連美國的embo和access看起來也相當不錯。那麼，只是結合您從新客戶的角度看到的情況，深入了解現有客戶？然後，隨著銷售團隊的擴大，這些人不會立即介入。通常需要一點時間。因此，將所有這些因素結合起來，您能否讓我們了解一下您真正指望在後半段看到這種加速，或者抱歉，今年最後 3 個季度，因為競爭變得更加艱難美國企業？

Yes. I really appreciate that question. Just so we can sort of level set. We addressed a lot guidance a lot more comprehensively, both on this call and in the Q4 call, where we laid out the very specifics. As you know, we said we had a lot of visibility with our international distributor orders and partners around the timing of their orders. And that's the main difference in those rates, together with the work that we already know and see on how our U.S. thrombectomy business is going to grow. We have a lot more predictability around those rates, and they're not dramatically changing those rates throughout the year. We've said that now twice. So it really came down the change in overall company rate was based on something we talked about last quarter's call and it turned out to be exactly what we said. And again, the focus on what is happening in the U.S. should be the best confident guide because the rest of that is relatively secure through what we have obtained from our distributor partners for the rest of the year.

是的。我真的很感激這個問題。這樣我們就可以設定水平。我們在這次電話會議和第四季電話會議中更全面地提出了許多指導意見，我們在電話會議中列出了非常具體的細節。如您所知，我們曾說過我們對國際經銷商訂單和合作夥伴的訂單時間有很多了解。這是這些比率的主要區別，以及我們已經知道和看到的關於我們美國血栓切除術業務將如何增長的工作。我們對這些利率有更多的可預測性，而且他們全年都不會大幅改變這些利率。我們已經說過兩次了。因此，公司整體利率的變化確實是基於我們在上個季度的電話會議中討論的內容，結果正是我們所說的。再說一次，關注美國正在發生的事情應該是最有信心的指南，因為透過我們今年剩餘時間從經銷商合作夥伴那裡獲得的信息，其餘的事情相對安全。

Okay. Appreciate that. And then, Adam, you mentioned these new products that are coming in CAVT and at least one by the end of this year. Is that a product that's going to be potentially going into a different part of the anatomy than we're accustomed to with Penumbra? Or any kind of just general thoughts on what we should expect from that one specifically.

好的。感謝。然後，Adam，您提到了 CAVT 中即將推出的這些新產品，並且至少會在今年年底推出一款。該產品是否有可能進入與我們習慣的 Penumbra 不同的解剖部位？或任何關於我們應該從那個具體期望中得到什麼的一般性想法。

Well, as we get closer and we're at this stage of the field, I'm not going to give more specifics for competitive reasons. But God, I can't wait to tell you. So please be patient. It's going to be an awful lot of fun.

好吧，隨著我們越來越接近，我們正處於該領域的這個階段，出於競爭原因，我不會提供更多細節。但是上帝，我迫不及待地想告訴你。所以請耐心等待。這將會非常有趣。

The next question comes from Mike Sarcone from Jefferies.

下一個問題來自 Jefferies 的 Mike Sarcone。

Just to start, do you think you can give us any color on -- in the U.S. VTE market, what you're viewing as kind of market growth for the quarter?

首先，您能否向我們介紹一下您認為本季美國 VTE 市場的市場成長？

It's historically always hard to really piece out market growth, i.e., new patients other than looking at centers that we have had 100% of their business for and see that they've grown. And that's been true. We have seen continued growth for several years now. So that growth continues. Obviously, particularly in VTE, that growth we've seen, which was really wonderful this year -- this quarter is also some market share, and that's even before Flash 2.0. So we'll wait to finish next quarter and see the effect of that. But I think it's going to be a combination, as we said in the prepared remarks of some significant share shift as well as some real significant catalyzing of adoption or market growth initiatives.

從歷史上看，要真正預測市場成長總是很困難，也就是說，新患者除了查看我們已經擁有他們 100% 業務的中心並看到他們已經成長之外。這確實是事實。我們已經看到了幾年來的持續成長。因此，這種增長仍在繼續。顯然，特別是在 VTE 領域，我們看到了這種成長，今年真是太棒了——這個季度也有一些市場份額，甚至在 Flash 2.0 之前。因此，我們將等到下個季度完成，看看其效果。但我認為這將是一個組合，正如我們在準備好的評論中所說的，一些重大的份額轉移以及一些真正重大的採用或市場成長舉措的催化。

And just a follow-up. You've been talking a lot about market access efforts. And I think you previously mentioned working with some of your hospital customers to kind of get data and work hand-in-hand with them to elucidate the benefit of CAVT in different vascular beds. Do you think you can give us any update on how those efforts are progressing?

只是後續行動。您一直在談論很多關於市場准入工作的問題。我想您之前提到過與您的一些醫院客戶合作以獲取數據並與他們攜手合作，以闡明 CAVT 在不同血管床中的益處。您能否向我們介紹這些努力的進展？

I'm not going to, for obvious reasons, go into specific systems and work that we're doing yet. I want to do the work first and we'll see the benefit of it. And then we can talk about it a little more openly. But I will tell you I'm really optimistic. There's a lot of understanding in the hospital community over what I think is one of the more important topics, which is people understand that clinically significant clot burden is really one of the most undertreated acute issues in health care. They understand the effect of not treating it. They understand the cost of not treating it. They understand more importantly than anything, the downside to patients for not doing it. And I think that allows these conversations to be as positive as they've been and get started on the work that we're doing. So I'm -- this quarter more optimistic. I've been personally involved in another -- a bunch of those conversations. And I'm very, very optimistic.

出於顯而易見的原因，我不會討論我們正在做的特定係統和工作。我想先做這項工作，然後我們就會看到它的好處。然後我們可以更公開地談論它。但我會告訴你我真的很樂觀。醫院界對我認為更重要的主題之一有很多理解，即人們明白臨床上顯著的血栓負擔實際上是醫療保健中治療最不足的急性問題之一。他們了解不治療的後果。他們了解不治療的代價。最重要的是，他們了解不這麼做會對患者造成的負面影響。我認為這使得這些對話能夠像以前一樣積極，並開始我們正在做的工作。所以我對這個季度更加樂觀。我親自參與了另一場——很多這樣的對話。我非常非常樂觀。

The next question comes from Richard Newitter from Truist.

下一個問題來自 Truist 的 Richard Newitter。

It's Sam on for Rich. First one on U.S. [thrombec] demand, apologies if I missed this, but I think before you had said you expect 27% to 30% within that range within U.S. thrombectomy for the year. Can we still think about that holding through 2Q through 4Q, just kind of plug in those numbers and I guess the 29% growth for this year in U.S. thrombectomy?

山姆替補里奇。第一個關於美國[thrombec] 需求，如果我錯過了這一點，我深表歉意，但我想在您之前說過，您預計今年美國血栓切除術的需求量將在27% 到30% 之間。我們是否仍然可以考慮從第二季度到第四季度，只要插入這些數字，我猜今年美國血栓切除術將增加 29%？

Yes. Thanks for the question. This is Jason. So we said last quarter, we reiterated on this call that we expect growth in U.S. thrombectomy to be within that range. Obviously, the first quarter, we were slightly above that range. It was a strong quarter. But our guidance still reflects that range each quarter for the remainder of the year and for the year. So that's where we're going to stick for now.

是的。謝謝你的提問。這是傑森。因此，我們在上個季度表示，我們在這次電話會議中重申，我們預計美國血栓切除術的成長將在該範圍內。顯然，第一季我們略高於該範圍。這是一個強勁的季度。但我們的指引仍然反映了今年剩餘時間和全年每季的這一範圍。這就是我們現在要堅持的地方。

Okay. And then similar sort of question on margin, a little over 200 basis points operating margin expansion in 1Q. Just kind of curious what you'd like to see in terms of trends in the business to get confident in increasing that 100 to 200 basis point range for the year?

好的。然後是關於利潤率的類似問題，第一季營業利潤率擴張略高於 200 個基點。只是有點好奇您希望看到什麼業務趨勢，以便有信心在今年增加 100 至 200 個基點範圍？

Yes. No, thank you. Obviously, with a good start of the year. We are very happy with our margin performance. At Q1, we typically see some normal material price increase and some investment in new product launch productivity. So for the remainder of the year, we will continue to see productivity improvements and improvement in product mix will continue. So we're pretty confident that we'll continue to see this margin trend expansion.

是的。不，謝謝。顯然，今年開局良好。我們對我們的利潤率表現非常滿意。在第一季度，我們通常會看到一些正常的材料價格上漲以及對新產品推出生產力的一些投資。因此，在今年剩餘的時間裡，我們將繼續看到生產力的提高和產品組合的改進將繼續。因此，我們非常有信心我們將繼續看到這種利潤率趨勢的擴張。

Yes. And I'll just add on to that. We said when we gave the initial guidance for 2024 on the February call, and we reiterated again this quarter that given the cadence of expenses that we traditionally see, we expected that operating margin expansion would be sort of in that 100 to 200 basis point range on a year-over-year basis for each quarter, which would obviously translate into that expansion for the full year. So it's important to understand sort of the cadence of our operating margins through the year.

是的。我將對此進行補充。我們在 2 月的電話會議上給出 2024 年初步指導時表示，並且本季度再次重申，考慮到我們傳統上看到的支出節奏，我們預計營業利潤率擴張將在 100 至 200 個基點範圍內每個季度同比增長，這顯然會轉化為全年的擴張。因此，了解我們全年營業利潤率的節奏非常重要。

All right. Are we still there?

好的。我們還在嗎？

Our next question comes from David Rescott from Baird.

我們的下一個問題來自貝爾德 (Baird) 的大衛雷斯科特 (David Rescott)。

I wanted to ask, Adam, I heard you mention that Flash 2.0 kind of optimized on some of the advantages of Flash 1.0. So wondering if you can give us a better understanding maybe about what's different in the system? And I heard some of the comments around pent-up demand for the system already. So just curious on what's baked into maybe that implied Q2 guide versus the full year, relative to those kind of demand comments and if and what and where, maybe Flash 2.0 could open up new opportunities for the company?

我想問 Adam，我聽到你提到 Flash 2.0 對 Flash 1.0 的一些優點進行了最佳化。那麼想知道您是否能讓我們更了解系統中的不同之處？我已經聽到了一些關於該系統被壓抑的需求的評論。因此，只是好奇第二季度指南與全年的暗示相比，相對於此類需求評論，以及 Flash 2.0 是否、什麼以及在哪裡，也許 Flash 2.0 可以為公司帶來新的機會？

Yes. Well, let me sort of first describe what we're seeing and hearing a lot of, which is obviously, Flash 1.0 did an extraordinary job. It took a great deal of clot out very quickly. What Flash 2.0 does, which is simply a change in algorithm and update in the algorithm, it didn't change the catheter or the catheter size. The 2.0 removes even more clot, even faster, without having to go to a bigger or less appropriate sized catheter. And I think the field is rallying around that. They're seeing the benefit of it. And as you know, word-of-mouth spreads pretty quick in this field. So we're seeing a lot of interest from folks who might not have wanted to try it in PE. They might have used Flash 1.0 in DVT. And that level of sort of interest is what I was alluding to. I think everyone continues to look to optimize the treatment for these patients. That's the key. You want to do the three things that matter the most, and we've said it before, but it's safety, speed and simplicity. And Flash 2.0 really checks those boxes, and that's the reaction that everyone is feeling right now.

是的。好吧，首先讓我描述一下我們所看到和聽到的許多情況，很明顯，Flash 1.0 做得非常出色。很快就排出了大量的血塊。 Flash 2.0所做的，只是演算法的改變和演算法的更新，它沒有改變導管或導管尺寸。 2.0 可以更快地移除更多凝塊，而無需使用較大或尺寸不太合適的導管。我認為這個領域正在圍繞這一點集結起來。他們看到了它的好處。如你所知，口碑在這個領域傳播得非常快。因此，我們看到那些可能不想在體育領域嘗試的人們表現出很大的興趣。他們可能在 DVT 中使用了 Flash 1.0。我剛才提到的就是這種程度的興趣。我認為每個人都在繼續尋求優化這些患者的治療方法。這就是關鍵。你想做最重要的三件事，我們之前已經說過，但就是安全、速度和簡單。 Flash 2.0 確實滿足了這些要求，這就是每個人現在的感受。

Okay. Great. And then maybe on Thunderbolt and the THUNDER trial. I heard the comments and trying to think maybe a little bit longer term, I believe with (inaudible), you had been able to maybe leverage some price already, and you discussed that in the past around helping that gain share. When I think about Thunderbolt, I guess, longer term and the opportunity that's out in the front still, do you still think that there's an ability to maybe command some type of price premium for a premium-priced product longer term when that comes to market?

好的。偉大的。然後也許是 Thunderbolt 和 THUNDER 試用版。我聽到了這些評論，並試圖從更長遠的角度思考，我相信（聽不清楚），您可能已經能夠利用一些價格，並且您在過去圍繞幫助獲得份額進行了討論。當我想到 Thunderbolt 時，我想，從長遠來看，機會仍然擺在眼前，您是否仍然認為，當高價產品進入市場時，有能力為長期的高價產品爭取某種類型的溢價？

Yes. I think if you step back and think about stroke, it's not a lot different from clot in the other parts of the body where the prices of products have risen as technology has developed and become more sophisticated. Right now, in stroke, people use a series of things. They might use aspiration and a stentriever. They might do this and that. So by the time you're done, we are not going to be more expensive than what a lot of people are already doing. They're just going to be using 100% of the Penumbra products because you don't need all of those ancillary tools when you have one simple system like Thunderbolt. And that's what we saw already. That's not me hoping and guessing that's what we spent the better part of the year with our CAVT portfolio in the rest of the body, particularly the most sort of closest example would be lightning bolt in the arterial system. The technologies are very, very similar, different sized catheters. And we've seen, obviously, an extraordinary increase in the usage of that product I think we'll see something similar with stroke. I think we'll be starting at a little bit different spot than we did with our older technology in the arterial side, which I think ultimately it plays to our benefit because we're starting with a pretty significant dominant position with a lot of competitors. So I think Thunderbolt just helps us going forward.

是的。我認為，如果你退一步思考中風，它與身體其他部位的血栓沒有太大區別，隨著技術的發展和變得更加複雜，產品的價格已經上漲。現在，在中風時，人們會使用一系列的東西。他們可能會使用抽吸和支架。他們可能會這樣做或那樣做。因此，當您完成時，我們不會比許多人已經在做的事情更昂貴。他們只會使用 100% 的 Penumbra 產品，因為當您擁有像 Thunderbolt 這樣的簡單系統時，您不需要所有這些輔助工具。這就是我們已經看到的。這不是我希望和猜測的，這就是我們今年大部分時間在身體其他部位使用 CAVT 產品組合的情況，特別是最接近的例子是動脈系統中的閃電。這些技術非常非常相似，但尺寸不同。顯然，我們已經看到該產品的使用量顯著增加，我認為我們會看到與中風類似的情況。我認為我們的起點將與我們在主動脈方面使用舊技術時有所不同，我認為這最終對我們有利，因為我們一開始就在許多競爭對手中佔據了相當重要的主導地位。所以我認為 Thunderbolt 只會幫助我們前進。

The next question comes from Mike Matson from Needham and Company.

下一個問題來自 Needham and Company 的 Mike Matson。

So I wanted to just ask one with Lightning Flash 2.0, you've incorporated software into the CAVT products. So is this sort of an opportunity to iterate on the product faster? In other words, could you -- could we expect to see 3.0, 4.0, et cetera, maybe over a year or something like that as you continue to improve the software?

所以我想問Lightning Flash 2.0，你們已經將軟體整合到CAVT 產品了。那麼這是一個更快迭代產品的機會嗎？換句話說，當您繼續改進軟體時，我們是否可以期望看到 3.0、4.0 等，也許一年多或類似的版本？

Yes, it's a great question. The premise is accurate. Obviously, with software that there's the possibility of faster iterations than hardware catheters and all the testing is very thorough, but it's a slightly different thing. That being said, so the -- can we continue to improve this. Probably, we're weeks into the launch, and it's going really well. So we haven't yet identified weaknesses that we have to fix. And I think that's a high-class problem for us to have or to improve. But over the course of the sheer volume of work we're going to do over the next year, I'm sure we will continue to make changes and improve. Obviously, the products that I alluded to, the 3 new CAVT products are not another version of the same ones. So there are newer products that cover different things than just improving Lightning Flash to 3.0. But yes, conceptually, that's possible.

是的，這是一個很好的問題。前提是準確的。顯然，使用軟體可以比硬體導管進行更快的迭代，並且所有測試都非常徹底，但這是一個略有不同的事情。話雖如此，我們能否繼續改進這一點。可能我們已經推出幾週了，而且進展非常順利。所以我們還沒有發現必須修復的弱點。我認為這是我們需要解決或改進的高級問題。但在我們明年要做的大量工作中，我確信我們將繼續做出改變和改進。顯然，我提到的 3 款新 CAVT 產品並不是相同產品的另一個版本。因此，除了將 Lightning Flash 改進到 3.0 之外，還有涵蓋不同內容的新產品。但是，從概念上講，這是可能的。

Okay. Got it. And then, Adam, I think it was you that made a comment about optimizing the commercial team in the prepared remarks. So I just wanted to see if you could elaborate on that? What that means, I guess?

好的。知道了。然後，Adam，我認為是您在準備好的演講中發表了關於優化商業團隊的評論。所以我只是想看看你能否詳細說明一下？我猜這意味著什麼？

Yes. So our philosophy has always been that we don't want the commercial team to lead the selling. We want the products to be wanted and then we have to have enough people to do the work and support those products. And we have always had what I consider the best commercial team ever assembled, and we've been extraordinarily proud of our commercial team for many, many years. We just had so much to do last year between the launch of both Flash and Bolt at the same time, the -- our peripheral embolization business, which is, again, market-leading technology. And on all these new customers that we talked about for a big chunk of last year. So we need more people to do the work. Those people are now here. They're on board. We were able to hire some of the best folks we could. So I think we have really -- today, an optimized size team. As this continues, could we -- would we add to it? Sure. It's not impossible, but it's certainly not in our plans anytime soon as we continue to go through this year. I think we got the team we need to drive the kind of growth we're talking about and serve the patients and physicians that we need to serve this year.

是的。所以我們的理念一直是我們不希望商業團隊主導銷售。我們希望產品受到歡迎，然後我們必須有足夠的人員來開展工作並支持這些產品。我們一直擁有我認為有史以來最好的商業團隊，多年來我們一直為我們的商業團隊感到非常自豪。去年，在同時推出 Flash 和 Bolt 期間，我們有很多事情要做，我們的周邊栓塞業務，這又是市場領先的技術。以及我們去年花了很大一部分時間談論的所有這些新客戶。所以我們需要更多的人來做這項工作。那些人現在就在這裡。他們在船上。我們能夠聘請到一些我們能聘請到的最優秀的人才。所以我認為今天我們確實擁有一支規模優化的團隊。隨著這種情況的繼續，我們可以——我們會補充它嗎？當然。這並非不可能，但隨著我們今年的繼續，它肯定不會很快出現在我們的計劃中。我認為我們擁有所需的團隊來推動我們正在談論的成長，並為我們今年需要服務的患者和醫生提供服務。

(Operator Instructions) Our next question comes from Shagun Singh from RBC Capital.

（操作員指示）我們的下一個問題來自 RBC Capital 的 Shagun Singh。

So Adam, you're targeting 16% to 20% growth here in '24 versus your initial directional outlook of plus 20%. I was just wondering, is there a pathway for you to return to that plus 20% growth? And what could potentially be the drivers of it? Is it Flash 2.0? Is it the new product that you alluded to that we could see this year? And then really, the question is how should we think about growth longer term for Penumbra. Is there a plus 20% base case on the horizon? And then just as a follow-up, on Q2. Just wondering if there's any color you can provide prior to today's call? Consensus was looking at 302 for sales and $0.61 for EPS. Any color would be great.

Adam，您的目標是 24 年實現 16% 至 20% 的成長，而您最初的方向展望是 20% 以上。我只是想知道，有沒有辦法讓你們恢復到 20% 以上的成長？其潛在驅動因素為何？是Flash 2.0嗎？這是您提到的今年我們可以看到的新產品嗎？事實上，問題是我們應該如何考慮 Penumbra 的長期成長。是否會出現 20% 以上的基本狀況？然後作為第二季的後續行動。只是想知道在今天的電話會議之前您是否可以提供任何顏色？市場普遍預期銷售額為 302 美元，每股收益為 0.61 美元。任何顏色都會很棒。

Yes. Let me start on the first part. We've always looked sort of our philosophy around guidance is pretty straightforward. We look and take into account all the information we have at the time we give our guidance, and that has been our approach for some time. So I'm not going to sort of deviate from that and sort of guess what could happen here or there. Obviously, we are extremely happy with where the business is. We feel an awful lot of excitement and momentum around the products that we've added to this field, and we're very proud of it. I think we'll leave like the guessing of guidance for a future time beyond what we've said. That also being said, and this is not meant as a comment around guidance, it's meant around a comment of the work we have ahead. I also said in the prepared remarks that there's 1.25 million people in the U.S. alone who have clot in their body that we should consider doing something about and are potentially now more able to do something about than we've ever been in the past. And obviously, that lays out the work we have to do, and that will obviously impact our future thoughts around how the business will grow. But it's premature to do that, and we're going to focus on what we're doing right now.

是的。讓我從第一部分開始。我們一直認為我們的指導理念非常簡單。我們在提供指導時會查看並考慮我們所掌握的所有信息，這一直是我們一段時間以來的做法。所以我不會偏離這一點，猜測這裡或那裡會發生什麼。顯然，我們對業務現狀非常滿意。對於我們添加到該領域的產品，我們感到非常興奮和動力，我們對此感到非常自豪。我想我們會像對未來的指導的猜測一樣離開我們所說的話之外。話雖如此，這並不是對指導意見的評論，而是對我們未來工作的評論。我還在準備好的發言中說過，光在美國就有 125 萬人體內有血栓，我們應該考慮採取行動，現在可能比過去更有能力採取行動。顯然，這列出了我們必須要做的工作，這顯然會影響我們未來關於業務如何發展的想法。但現在這樣做還為時過早，我們將專注於我們現在正在做的事情。

Yes. And Shagun, to your second question, we reiterated today sort of the cadence of revenue growth we expect through the balance of the year. And we said the same thing on the initial guidance call in February. We're the first part of the year, we expect it to be in the mid-teens range. Today, you obviously saw us report growth of a little over 15%. And we said that the second half of the year, we would see at the top end of the range or above. And part of that is the visibility we have in the international cadence. And of course, we've talked a lot about our U.S. thrombectomy business, and the commercial team and products, Flash 2.0 among them there. So I think you have -- we try to be comprehensive in my prepared remarks to give you the components of the business to set up your models. But happy to take any follow-ups, if that's not enough.

是的。沙貢，關於你的第二個問題，我們今天重申了我們預計今年剩餘時間的收入成長節奏。我們在二月的初步指導電話會議上也說了同樣的話。我們是今年的第一部分，我們預計它會在十幾歲的範圍內。今天，您顯然看到我們報告的成長率略高於 15%。我們說過，今年下半年，我們將看到該範圍的上限或更高。其中一部分是我們在國際節奏中的知名度。當然，我們已經談論了很多關於我們的美國血栓切除業務、商業團隊和產品，其中包括 Flash 2.0。因此，我認為您已經——我們嘗試在我準備的發言中做到全面，為您提供建立模型的業務組成部分。但如果這還不夠的話，我們很樂意採取任何後續行動。

There are no further questions at this time. Ms. Furlong, I turn the call back over to you.

目前沒有其他問題。弗隆女士，我把電話轉給你。

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 second 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二季電話會議的最新情況。