Good afternoon. My name is Bill Plovanic. I'm a Senior Medical Device Analyst here with Canaccord. Welcome to the Canaccord 45th Growth Conference. With us up next, we have Penumbra, and for Penumbra, we have Shruthi Narayan, who's President of Interventional. With that, we are going to go straight to a fireside chat with Shruthi. Thank you for joining today. Let's kick this off. Usually we do a quick PowerPoint presentation, so I feel like we're diving right in here. Let's talk about the commercial organization. You've made some changes. I think we get a lot of questions on that, but you highlighted on the Q2 call that you've added a separate sales force for peripheral embolization. Why did you make this change? It's a pretty big shift for you. When did you start it? When have you completed it? How should we just organize this for me? Yeah, absolutely. It's a great question. Penumbra is the global leader in thrombectomy, as you know, from head to toe. The last few quarters, we've introduced the CAVT technology, Computer Assisted Vacuum Thrombectomy. What you're seeing from that is a pretty significant sort of demand from our physicians to adopt the CAVT technology. We've seen over the last three quarters, 40%+ growth in the VTE segment, which is sort of the largest of that CAVT segment. With that share shift and the continued demands of our physicians, we said, you know, let's look at how we can have our existing team be 100% focused on that larger CAVT opportunity. What we also have is great embolization coils that are loved by our physician customers. For us, we just said, let's bring this sales team on, but have them now focus on the embolization coils so that our existing team can be 100% focused on the larger CAVT opportunity. In the process, almost we got lucky. We got this new product, Excel, that just got cleared from the FDA. For us, we've been in the mode of getting the new team up and running, trained so that they can then go in and introduce this new product to our customers. We're still in the very early innings. We had about a week and a half or so of Excel activity in Q2. This is the first sort of full quarter of the launch of that new. Okay. Sorry about that. Yeah. Sorry about that, guys. Is that too loud? Okay, great. Should we start all over? No, just kidding. Recap that quickly. Was it something you were seeing with the sales force? Were they just not selling the embolization products? Was it just because you have the new product coming on? How is it, just you felt like it's too big? We need to split the opportunity. You mentioned it, but you didn't kind of dig deep. Just. Yeah, you know, it's more of a proactive effort because we see the, you know, the CAVT opportunity, you know, on the arterial, venous, and pulmonary side. There are 800,000 patients that have blood clots each year in the U.S. Only about 10%- 15% of them are getting access to any sort of advanced therapy. The share shift has certainly been happening. That tells us from a technology standpoint that our physician customers are responding well to it. There are other catalysts like, you know, clinical trials that, you know, if readout positive, will be additional sort of momentum for the field. At the same time, though, I guess it's a good problem to have. We have these really amazing coils that our physicians love. We said, let's bring on a new team to support the embolization franchise. The timing of Excel certainly, you know, proved to be an additional kind of benefit there. Okay. Yeah. Now the caliber of the team we've brought on, I mean, we've been absolutely blown away and sort of front-loaded our investment because of that, because of the talent pool, really high caliber reps that, you know, come from spaces like aortic and the TAVR spaces, sort of career reps, you know, they're looking for a stable place where they know there's, you know, good reputation for product innovation, trial work, and so on. That's really what we're seeing in this round of hires that we just. When did you start hiring and complete that process? Just in the first half of 2025. Throughout the first half. Yes. By the end of June, you were all set. Yes. Everybody's trained, hit the ground running. Yeah, we just had our last class that completed training last week. Okay. Yeah. We should, just from a contribution standpoint, this is maybe a little third quarter, more so fourth quarter and beyond as you typical ramp wrap up. I would say that the team's just getting up and running, going out and meeting customers and doing all that. Also, of course, launching the new product. We do expect that to sort of ramp here in the back half of the year. I think you said, from the Q2 call, you had about 50 embolization reps and 40 vascular clinical specialists. Embo, I think kind of makes sense, but the vascular, what's the. The clinical specialist. The separation, yeah, of kind of stayed there. Yeah. That is just, we've had clinical specialists within our organization over the years. This was just the continued sort of growth of that team. It's the team that's involved in supporting the cases. They're involved in in-servicing our physician customers and kind of answering, you know, some of the questions the staff may be having for these procedures. We just organically always add appropriate, you know, support staff as the need arises. This call out here was that in the first half of the year, we brought on, you know, this group of the 50 embolization reps as well as 40 clinicals that will be supporting both the teams. Is an account managed by like one senior rep and then all these people report up into that kind of rep manager, or how does the structure work? Great question. Actually, when we did this, we had the sales management team or the leadership team—we call them the Regional Managers and the Area Directors—continue to manage both the embolization team as well as the thrombectomy team. That continues to foster the culture, the positive environment, and so on, as a new team gets onboarded. Outside of that, usually a rep or a couple of reps have, you know, one to two clinicals. It really sort of depends on the territory and the volumes and the geography that it spans. Okay. I'm going to switch over to thrombectomy. Just how do we think of both the first half performance overall and then the different segments, vascular, arterial, coronary, peripheral, you know, and then stroke neuro? As we think about the drivers kind of going forward, I'm going to kick it off with stroke. We've heard that, you know, post the Mevo data, like for the stent retrievers that kind of slowed the market down. What have you seen and what do you think, you know, as we think about moving into just Thunderbolt and timing there and thoughts on the impact? Yeah, so in stroke, we've seen continued sort of just share shift towards Penumbra. That certainly played out in Q2 as well, and it was ahead of market growth. We're seeing sort of continued interest from the physician community with our RED 72 Silver Label, which is sort of the first full quarter of its launch was Q2. Outside of that, some of the MeVO trials certainly, I guess, confirmed for physicians what stent retrievers end up doing, and that was sort of what the results showed. That being said, a lot of physicians have already moved more to an aspiration frontline approach for these procedures. There are either single institution-based data sets or other sort of meta-analyses kind of data sets that are showing that aspiration is helpful for these patients. We haven't really seen much of that playing out on the aspiration side. It may be more of a stent retriever dynamic. Beyond that, I think the stroke field in general is all eagerly awaiting modulated aspiration because you've seen some of the results from some of these large bore trials that maybe haven't really shown much of a benefit. Based on all that, the physician community is eagerly awaiting modulated aspiration with Thunderbolt. Yeah, let's talk about that. I think, you know, for those that know you, we understand the benefits of the CAVT technology. As we, you know, we've seen what it can do in peripheral, what are the key, like one, two, three top benefits we should look for coming out of the Thunderbolt trial, the Thunder trial, and kind of what is going to be the driver of adoption for that product? Why are they going to pull your product off the shelf versus anything else for a stroke market? Yeah, absolutely. I think what the modulated aspiration concept is geared towards is when it's interacting, you know, when the catheter is interacting with the clot, how consistently can we pull the clot out, ingest it in a matter of, you know, a short time, and ultimately have that sort of predictability over a wide range of clot morphologies, right? The Thunder trial will look to answer some of the normal questions you would expect from any of the stroke trials. Beyond that, I think a factor that will start to play into the concept of modulated aspiration is what it does when it's interfacing with the clot itself, right? That predictability, the consistency, as well as the time will be factors that the physician community will want to know about. In terms of why they would pull this versus something else, if you look at the stroke field in general, there were the stent retrievers from back in the day, aspiration, which has proven to be sort of the market leading option, the option that physicians gravitate to because of the time and the simplicity of it, with some of these other modalities ending up becoming more adjunct in a minority of cases. The next sort of phase of the field was this exploration, if you will, of all these large bore devices that became available. Ultimately, I think the results have shown that they maybe haven't really been able to prove much of a benefit. The next innovation that physicians are all looking for is modulated aspiration. They've seen what it's done for their counterparts that are dealing with patients in the rest of the body. They've seen what it can do in terms of the safety profile, the speed, the simplicity, and that is sort of what they're excited about and eagerly waiting. Is it, do you also get like better first pass success and or, you know, does this allow you to maybe go into other vessels, like go deeper with a smaller catheter or what? How should, you know, kind of the, you know, I'm a finance guy, not a doctor, right? As I think about this, what else can I get out of this longer term? Does this have more TAM expanding opportunity beyond where we are today? What can it do? Yeah. Just for the current market. Yeah. If you take the current market, in procedures where they're still using, let's say, adjunct devices like stent retrievers, things like that, there is more share to be gained. Red 72 Silver Label, like I mentioned earlier, has already been taking share. We expect that to continue versus other aspiration catheters with Thunderbolt. Anytime there's new innovation, there is growth in the market typically. You would expect to see some of that. I would say it's a combination of all of these and how you model that, I think, is maybe looking at some of the past innovation and so on and how that's affected the fields. Overall, I think stroke is in a really great spot because as technology gets better, you can start to offer this therapy to more and more patients. Now, specifically in the Thunder trial, we looked at the Red 72, the 68, and the 62 were the devices used in the study. The data will all reflect the usage of those devices. Okay, I am speechless for a second here. Wait. All good. Get to the rest of my questions. I'm going to switch over to the vascular market. We'll start with the VTE now. Just, by your own admission, you've done well in the U.S. VTE market. I think it was up 42% in the last quarter. Not a lot of uptick from Q2 versus Q1. Just talk a little bit about market dynamics and then how much can the VTE segment of the peripheral thrombectomy market grow as you move from early majority into late majority of adopters, especially without more data to change guidelines or, we won't get that. I think STORM-PE is really the next incoming, but not on the DVTs, that's PE segment. Just kind of how do we, you know, it seems like there's been a big penetration, but can you keep growing or do we need another data set to kind of really re-excel? I mean, 42% growth is fantastic, but to keep that kind of party going. Yeah, you know, it's been an interesting kind of just path the last few quarters as, you know, the physician community has been hearing about CAVT and what it's done for their, you know, the patients of their colleagues. It's usually word of mouth or at physician conferences that they hear and see the latest developments with CAVT, and that has led to the sort of share shift and the movement towards CAVT as we've seen it. As you called out, STORM-PE, if positive, will be a catalyst for PE. Beyond that though, you know, we've invested pretty heavily in our market access efforts because as we become the majority in VTE, which we are in DVT, the next sort of work is to make sure the remaining, you know, 90% of patients that are not getting access to advanced therapy get access to advanced therapy. We have alluded to the work with large hospital systems to look at the impact that CAVT is having on their patients, both from a clinical standpoint as well as a health economic standpoint. As those data sets start to read out, hospital systems are organizing their efforts to make sure, you know, more patients get access to advanced therapy. I think that is generally favorable for CAVT. Then beyond that, constant innovation, you know, that's something that has been core to Penumbra, and we will continue to innovate in the months and years ahead. We're pretty excited about what's to come. I think, as I alluded to the STORM-PE, at least on the investment community side, we're really focused on that just because it is against standard of care, right? We haven't seen that on the DVT side yet. Do you think that you can get deeper penetration into the DVT? I mean, your strategy is market access, but do we need clinical data to change guidelines, to change referrals, to change just the whole thought process, right? They can see what the technology does, but sometimes it just may not even get to the hands of the right doc. The patient may not have to get to the right person to get the thrombectomy procedure, right? Yeah, I think it's actually the clinical data on the DVT side for iliofemoral DVTs, that's already been proven that iliofemoral DVTs would benefit from treatment. I don't know that there's necessarily clinical data still needed in that space. I think it is a function of what you alluded to, which is all the different physicians that are in the patient's care path. Do they all know about the newer options that exist versus some of the more traditional options like just an oral anticoagulant? I think that's where the market access efforts can actually play a role because that's the point. Get the word out to the non-interventional community that's seeing these patients because the interventionalists already know what the latest options are. It's about that additional raising awareness. That makes sense. Obviously, there was the major acquisition last year, Stryker and Inari. Just market dynamics post that acquisition. Obviously, I mean, I think even Stryker mentioned on their earnings call that maybe they shouldn't have had them all sign non-competes, try to get them to all sign because some of them obviously didn't. Did you benefit from some of that? What have you, what's the market done? Kind of how should we think about that? Was that settled down? It's because maybe you had an opportunity to take a little and then it kind of hits a baseline again. Just how, where are we dynamically in that whole process? Yeah, I think they commented on some of the things that they were seeing as part of it. I mean, for us, you know, we started seeing the shift towards CAVT even prior to the acquisition, right? That sort of innovation has led to the shift that we've seen happen, and that's continued into the course of the last two quarters here in 2025 as well. We expect, I mean, our team's continuing to do the work. I think we're very excited about the trajectory ahead for Penumbra and CAVT. How should we think about, you know, incremental competition? I think Imperative Care has been very vocal about building a large sales force to launch with once they get their PE label. You know, how do you think as we go from three to four to five to six to seven players, how are you viewing future pricing? I, not to answer the question for you, but obviously I think you're the only player with CAVT. They're all coming in with kind of the standard products. How do you just see the market dynamics and your internal view for the next couple of years with all that increase, competitors? Yeah, great question there. What I will say is that, in terms of how we, you know, view the overall opportunity, CAVT is differentiated from all the other analog devices out there, right? Most of the other options that are either in trials or going to enter the space are all still looking at more of the basic approach to aspiration, which is either hooking up to a syringe or a pump. At this point, CAVT has clearly shown an improved safety profile and improved, you know, procedure time, more simplistic. Based on all that is why physicians have started to move towards this sort of a therapy. I think anybody else coming into the space is going to have to explain how they're better from a time and a, you know, safety profile standpoint. At this point, that's, I'm not going to say impossible, but it's going to be harder and harder to do as CAVT and there's more and more constant innovation that we're going to bring into the fold. Beyond that, you look then at, you know, for example, the stroke space where we've dealt with, you know, fair share of other technologies that have come and gone. I think it's a function of continuing to innovate and continuing to make these procedures faster and safer is how we win the sort of longer term opportunity. All right, we have a couple minutes left. I sneak a question in on coronary. You had the CHEETAH data a couple of years back. You've got the CAT RX. Do you plan on a CAVT product there? Who do you really compete with in that space, and how have the dynamics changed post the CHEETAH data? I think a decade ago there were companies trying to do things that were high expectations. Is this something we can kind of see the CAVT come in and do something there? Yeah, you know, we're always looking, we're always evaluating. It's about, I think, 200,000 or so patients that have blood clots in the coronaries. What is interesting in the original CHEETAH trial is that CAT RX, our technology that is used in the coronaries, was in the body for, you know, 69 seconds, right? It pulled out the kind of clot, had the results that it did, which is why we end up being the default choice in the procedures that are being done. The other technologies that exist are back to the basic syringe-based catheters that have existed for 20 + years. It isn't really a function of competition or anything like that. Does CAVT have a role? We'll always evaluate, but like I said, CAT RX was in the body for 69 seconds, right? That's in general what you're seeing in these procedures. Is there really a need for CAVT? We don't know yet. That being said, things always change and we will respond as appropriate. Different physician societies are looking at data and things like that to compare against traditional methods and show that CAT RX is actually proving to be a benefit. Those are all happening more through sort of the physician community themselves. Okay. I'm actually going to switch over, arterial real quick. Just how did that do in the first half, and how should we think about the future growth there, especially with 6X and hitting the market? Yeah, so with arterial, after VTE, arterial was the next sort of strong growth driver there in Q2. It continues to be a story there of us being the market leading option, but with constant innovation, you're switching more of those customers that were previously using maybe open surgery for their patients. As technology has gotten better, and they get more familiar, we're seeing more procedures switch over to endovascular first, CAVT at that. Beyond that, devices like 6X help them access smaller vessels, other sort of vessels that maybe were previously our Bolt 7 was too large to go and access. Those are all the sort of drivers, I guess, on the arterial side, continuing to see that shift from open to endo and then making sure they have options for all the sort of vessel sizes that they're typically dealing with. Beyond that, I think the market access data THRIVE was one study that was presented at BAM earlier in the year. Again, it's showing similar to STRIDE that patients do better clinically and it's cost effective. When you have that story to tell, it's a pretty compelling one. That's what we're seeing in the reaction. I think we're out of time, but I'd like 30 seconds more if I could just on international and then the European launch of, you know, the Flash and Bolt technology. Kind of how should we think? What's the impact been or when do we start seeing the impact of it? Then just China, a lot of craziness going on there. Just what, what, how should we think about that? Yeah, I think international in general, we spent the last couple of years focusing on the places where it made sense to bring the latest technology, getting out of places where it didn't make much sense. We're really seeing the fruits of all that labor pan out here. International has been a strong part of our story this past quarter, and we expect that to continue. China, we have a great partner there. We work closely with them. I think the overall, the bigger economic backdrop is, we're looking to adjust as things change. In our guidance, we haven't really factored China into the back half of the year or anything like that. That all being said, we have a really strong relationship with our partners there, and when things change, we can quickly sort of support them as they need. That's sort of our view on China right now. All right. I think we're going to wrap it up there. Thank you so much. Yeah, of course. Thanks.