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| Statement |
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| 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 |
| 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 |
| So yes, I think 2024 is going to be a good year for our stroke business and so we're going to continue to see some growth there |
| 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 |
| We expect positive operating cash flow trend to continue in 2024 |
| 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 |
| We also delivered more than 20% year-over-year growth in stroke thrombectomy in the U.S |
| That business is really strong |
| 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 |
| 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 |
| We delivered another record quarter of profitability in the fourth quarter |
| 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 |
| thrombectomy to be consistently strong in this range throughout the four quarters of the year |
| Our gross margin, we're continuing seeing favorable product mix |
| Where do you kind of see the margins moving in the long term? Maggie Yuen I think, yes, we're very pleased with our profitability this year |
| business to deliver strong, consistent growth in the 22% to 25% range throughout the year |
| And we came really close and I'm pretty proud of that, given the scale of growth in the transformational aspect of last year |
| But in every event, it is market growth, it is things like that internationally, I think we have pretty good visibility |
| But for now through this year, I think we're in really good shape |
| Part of that strong growth is market growth, which is healthy |
| So that the professionalism, the ability to move in and pick up quickly has been pretty remarkable |
| 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 |
| Further, the next three 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 the 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 |
| So we feel pretty good about it |
| And we have very good visibility into the timing |
| What's not to like about that? That gives us an extraordinary amount of confidence about 2024 and beyond with the success of this |
| 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 |
| So again, we remain very optimistic about the sort of one, two punch there with those two products |
| 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 |
| Statement |
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| But obviously it fell just shy the consensus number |
| But this is the first time you've missed Street numbers since the IPO |
| thrombectomy numbers because that's where I think you're going to be greater the hardest |
| One, we are hearing about increased payer scrutiny on mechanical thrombectomy |
| How do we think about the amount of stocking that we're 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 what's not to be like? And yes, I acknowledge without a doubt that there's a couple of million dollars short from the consensus still within our guide |
| However, it will be profound and extremely motivating |
| In fact, we saw the opposite this year |
| So I guess the lower end of the revenue guidance is 16% |
| I’m curious how that may or may not be impacting you |
| Neuro embolization was $5.9 million, a decrease of 33.8% and other revenues was $3.3 million, an increase of 46.3% |
| Adam Elsesser 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 |
| That’s quite a bit of deceleration |
| 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 |
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