Good afternoon, everyone. I'm Robbie Marcus, the med tech analyst at J.P. Morgan. Very happy to introduce our next company, Silk Road Medical. I'm gonna bring up Erica Rogers, the CEO, for the presentation. We'll do some Q&A. Erica. Thank you, Robbie. It is always a great pleasure to be here at J.P. Morgan. I can't think of a better way to kick off the year. Thank you so much for being in the audience at 4:30 in the afternoon on Tuesday. I know I am separating you from your Dry January cocktail, so we'll get through this and get you off to your 1st cocktail party as quick as possible. All right, a little bit of legalese before we start. I just wanna remind you that Silk Road has not pre-announced the results for Q4, nor have we given the full year 2022 results. Similarly, we're neither issuing guidance nor reinstating our existing guidance. Enough of the legalese. We are standing here today extremely excited about our growth prospects. 2023 really represents the year of growth, the year of leverage for Silk Road Medical. We'll get into some of the details around that in a minute. We have established three strategic priorities for the year. Number one, grow. Grow through expanding physician adoption, driving TCAR adoption in our already trained user base of physicians, and we will do that through strong commercial execution. I'm super excited today we have our Chief Commercial Officer who's joined us, and you'll have a chance to ask him some questions after my presentation. Our 2nd priority today is to strengthen the business. We have spent the last five to six years really laying a foundation for growth, opening hospitals, training physicians, establishing sales territories, establishing a manufacturing footprint in two places, and hiring the SG&A team behind the scenes to operate this business. From there, we will grow, and our Chief Financial Officer and Chief Operating Officer, Lucas Buchanan, is also here with us today, so you can grill him on our path to profitability. Finally, our 3rd priority for the year is to diversify. When we talk about diversify, we're really talking about two things. Our goal has always been to make TCAR the standard of care globally for the treatment of carotid artery disease, so we will continue our global expansion. Our priorities have been Asia-Pacific so far. We're working on some regulatory strategies there, which you probably heard about in China and Japan. In addition to that, we will continue to expand on our core competencies. We have established the transcarotid access route, and we are experts in neuroprotection, and we will continue to leverage those two things as we think about new disease states and broadening our portfolio. Zooming in a little bit on growth, our number one priority is growth. We have, over the last 5-6 years, established a commercial infrastructure. We started out with five sales professionals in 2017. We ended 2021 with 58 sales territories, going to 70-75 in 2022. This has been all about establishing this commercial infrastructure. We have established a broad clinical footprint. What does that mean to us? We've trained physicians, in fact, we will have ended 2022 with greater than 2,400 surgeons trained on how to do TCAR. We've also opened hospitals. We are in roughly 1,000 hospitals in America, those hospitals control the majority of carotid artery disease. We have laid that foundation. Finally, the final piece of the puzzle was put into place last year, which was full market access. We are very pleased to say that we achieved FDA approval for standard surgical risk for TCAR. This gives us access to the full $1.2 billion market opportunity in the United States, against which we are only 11% penetrated with room to grow. TCAR has been firmly established as the less invasive standard of care for stroke prevention. The only other way to do stroke prevention today reliably is carotid endarterectomy. That's a 70-year-old procedure. That is the business we're in converting carotid endarterectomy to TCAR. We believe that now is the time that every patient has the right to the best possible outcome from the treatment of their carotid artery disease, and we are committed to reducing the risk of stroke and its devastating impact. In fact, the consequences of stroke are devastating to the entire United States. It's the fifth most common or the fifth most common cause of death in the United States today, and there are greater than 7 million survivors of stroke with debilitating consequences from that stroke. In fact, I was just chatting with a gentleman before this talk who that hits very home for him. He knows somebody who had a devastating stroke impact. Probably many of you in the audience know people who've had a stroke and how it devastates their lives. All of this leads to great consequence and cost. In the United States alone, there's a $50 billion annual cost to related stroke complications. When we think about where does ischemic stroke come from, about a 3rd of all strokes in the United States are as a result of carotid artery disease. It's one of the leading causes of stroke in the US. There are about 4.3 million Americans walking around with carotid artery disease, and about 430,000 of those people are diagnosed every year with a critical carotid stenosis. What does that mean? That means they've had a Doppler ultrasound exam of their carotid artery, which tells the treating physician what is that degree of stenosis, and that means it's severe. This is a patient who needs to be on best medical therapy, on a statin, on aspirin. We need to watch that lesion to make sure this patient is not at risk of stroke. Every year, 430,000 people are diagnosed in the U.S. When we look at our global market opportunity for TCAR, make no mistake, our goal is to become the standard of care worldwide. We consider this a $5 billion global market opportunity. Now let me break that down. First of all, in the United States, the lowest hanging fruit are the patients who are treated today. That's about a $1.2 billion market opportunity, just the patients treated today. Job one is to convert that $1.2 billion market from largely carotid endarterectomy to TCAR. That's where we're about 11% penetrated today. The 2nd focus is to think about all of those patients diagnosed with a critical carotid stenosis and see if we can expand this market by lowering the upfront cost of the procedure, the upfront morbidity and mortality. We've seen across medicine, when we do that effectively in cardiovascular disease, there's generally a market expansion effect. We're not there yet. We're still working on the patients who are treated today. Similarly, when we look at the global opportunity, we size that at about $2.3 billion. That's just the patients who are treated today in the major markets around the world of Europe and Asia-Pacific and South America. I talked about our recent label expansion in the United States. What's so exciting about this, it's the 1st time in 70 years that a minimally invasive procedure has been on a level playing field with carotid endarterectomy. 70 years. Finally, FDA approved standard surgical risk, and finally, CMS agreed to reimburse for standard surgical risk. Not only did that expand our TAM, our total TAM, to about 170,000 procedures per year, it also legitimized TCAR in the eyes of treating physicians and referring physicians. We have spent the last 5-6 years, as I told you, establishing this clinical footprint of trained physicians and opened hospitals. Those trained physicians have produced data on now greater than 18,000 patients published in high impact factor peer-review journals. Journals such as JAMA, the Annals of Surgery, the Journal of Vascular Surgery, and Stroke. What's important about these papers is they not only get to the treating physician, they're not only seen by the vascular surgeon doing this procedure, they're also seen by the internist, the cardiologist, the neurologist, the referring physician community, who is beginning to understand that TCAR is on a level playing field with CEA. By that, we mean lower periprocedural stroke and death rates, lower odds of a cranial nerve injury, lower odds of a heart attack associated with the procedure itself. Finally, importantly, a lower odds of an extended length of stay. This is important when we talk about the economics, which I'll get to in a minute. For the 1st time, Silk Road is really turning our attention to prioritizing the patient and prioritizing patient education. You might ask, "Well, why didn't you do this before, Silk Road?" We have. We've put some effort into patient education. Without the access to the entire addressable market, it didn't make sense to really drive patients toward this procedure, only to have them turned away at the door because they didn't meet the FDA or CMS criteria. Now is the time to really make sure that every patient diagnosed with carotid artery disease understands their treatment options. Why do patients like this? We know they like it because we've asked them. In fact, we're referencing some data here that we've collected internally. We ask patients, "You've had a TCAR, you've had a carotid endarterectomy. Let's compare the two of those." When you compare the two of those, as you can imagine, hands down, patients choose TCAR every time, and patients would tell their friends to have TCAR every time. That's because there's a shorter length of stay. There's a shorter recovery time. There's less pain. You can do this under local anesthesia. Importantly, in the standard surgical risk patient population, some of those patients are still working, and they can get back to the job, back on the job sooner. We have built a strong foundation for growth, and I talked about those early days. If we just look at 2018- 2022, we've had a four-fold increase in market share against carotid endarterectomy, resulting in, at the midpoint of our guidance, $135.5 million in 2022. Yet that represents only 11% penetrated. We see significant opportunity ahead as we continue to drive from our strong foundation. We have ushered in this new era of transcarotid therapies. This is the 1st ever and only transcarotid market. In fact, we have established a brand-new category. You've heard of TAVR, you've heard of EVAR, you've heard of all these other acronyms. Most of those acronyms were established by multiple different companies going at it all at the same time. Silk Road singlehandedly, single company, has established TCAR as a brand-new category. Has shifted the paradigm to transcarotid. When we think about the TCAR procedure, we have now five very specific products that go into a TCAR procedure. The two flagship products are the neuroprotection system. That's our flow reversal system that reverses blood flow away from the brain during the stenting part of the procedure, so that any debris that are liberated come backward away from the brain and get trapped in this filter housing, which I'll show you in a minute. The second flagship product is the stent. This is the ENROUTE Transcarotid Stent System. It is the only stent in the world indicated for transcarotid delivery. Coupled with that are some accessory products that make TCAR faster, they make TCAR easier, they make TCAR better for the physicians, and that's an access kit to get into the artery. That's a guide wire. Most recently, we're super excited about the balloon. We received FDA approval for the 1st and only transcarotid-indicated angioplasty balloon. As you probably know, we're in a limited market release on that balloon right now. To date, as of September of last year, we've performed greater than 55,000 TCAR procedures. As we like to say, the proof is in the filter. This is what they often look like after a procedure. All of that debris that you see in that filter would have gone to the brain and potentially caused a stroke. There are some efficiencies I talked about built into the TCAR procedure, namely in procedural time. This was made never more important than it was in the pandemic. This turned out to be an interesting tailwind for TCAR. You can do a TCAR in roughly half the time it takes to do a carotid endarterectomy, so you're more efficient throughput in the operating room and more efficient utilization of strained hospital personnel resources. In addition, that leads to reduced cost relative to that reduced operating room time. What does that mean for hospitals? It means that the margin is greater. When you do a TCAR versus a carotid endarterectomy, you make more money as a hospital. These procedures are relatively profitable anyway for hospitals, we make that picture even better. When you factor in the length of stay and the complications from carotid endarterectomy, this picture gets even better. These are the tailwinds that have led to growing TCAR and sustained TCAR adoption. What you see here on the orange bars are U.S. procedures, quarter-over-quarter growth, save those pandemic quarters, which I'm sure you can all see from a mile away the pandemic quarters. Quarter-over-quarter growth and procedural growth, which we are extraordinarily proud of, which has led to an overall strong growth profile on the revenue line. In fact, one of the things we're most proud of is the correlation between utilization and revenue growth. Those things are strongly correlated. This is a business of utilization. We have shown a five-year revenue CAGR of 57%. In summary, Silk Road has established a brand-new category. We are the sole player in this expansive greenfield opportunity to which we are only 11% penetrated today. We have established a strong moat, strong barriers to entry with the only carotid-dedicated sales organization in the world and an unsurpassed, insurmountable mountain of clinical evidence supporting the use of TCAR over carotid endarterectomy. With that, I'll say thank you. I'll invite my colleagues up, and Robbie will take some Q&A. Great. Erica, it's funny, I was mentioning to you before the session what a difference a year makes. I'm serious, what a difference a year makes. All that you've added in terms of approval and reimbursement since last year, it really has opened up the story and the adoption for TCAR. Maybe we could start there. You talked about in the slides, but, you know, you used to go in and talk to doctors, and you'd get some pushback. What are the discussions like now when you go in? A lot of doctors have already been educated, but what's the discussion like with some of the holdouts that are now adopting the therapy? Right. Well, as I said in my prepared remarks, I think there's two things at play here, Robbie. First and foremost, the standard surgical risk approval from the FDA was based on real-world evidence. The data that were used to support that regulatory approval came from the Vascular Quality Initiative, and those data were packaged up in a PMA supplement to expand the label. FDA agreed with us that the evidence was overwhelmingly in favor of expanding the label to standard surgical risk. Physicians know that, so this has given kind of a legitimate halo effect to TCAR. It's for the 1st time put TCAR on a level playing field with carotid endarterectomy. I don't know, Andy, if you want to add some color from the ground on how it's going with standard surgical risk. Yeah, do I have to push this? Yeah. No. Okay. Okay. Okay. Just wanna make sure. We've talked a lot about this. We've spent a lot of time in the early years of launching TCAR to educate doctors on high surgical risk language. They don't speak the standard surgical risk language. We now fast-forward to our expanded label indication, and we have to say, "Forget everything we told you. We're on an even playing field now. You can treat any patient that comes into your clinic that has carotid artery disease, and you can make the best clinical decision for them without having a lot of sand in the gears to try to figure out what anatomic or physiologic risk factor there is. That is been one of the critical things that we're trying to communicate and educate our customer base on, is that they no longer have to figure that out. They can just make a clinical decision, not have to worry about reimbursement. That is a process, but one that we're continuing to leverage across all segments of our physicians based on their therapy adoption. If I look at the 3rd quarter results, which was your 1st full quarter after getting reimbursement for standard surgical risk, we saw a huge jump in utilization per physician. I guess, let me ask it this way. Do you think there was anything one time in nature, like pent-up demand of surgical risk patients, or do you think that's more the start of a new trend line going forward with utilization? Well, let me give some color to Q3, and we're as excited as you are about the results in Q3. There were kind of three things that came together to serve as a tailwind. Number one, 1st and foremost, was the standard surgical risk label. Here's what's interesting, Robbie, is that a minority of our customers performed a standard surgical risk procedure in the quarter. There's lots of room to run here. The halo effect of the approval and the legitimizing of the therapy is probably what is driving, more than anything, the results in Q3 on the per procedures per physician basis. There were a couple of other things at play. Number one, we had executed against our territory growth. We said we'd go from 58 territories to 70-75, and we got there. Which means we had a couple of quarters of benefit of increasing the face time of our quota-carrying professionals with physicians. We know from our own data that is a significant driver to adoption. That was really at play in Q3. Finally, you know, as I said on the call, it was a relatively more normalized operating environment in healthcare. By no means was it perfect. There are still labor constraints, and there were in Q3, but it was better than it had been in a long time. Really what you saw is what we came here to do which is drive the business in a normal healthcare operating environment. How much legwork do you and your sales organization have to do to educate and drive use? Is this something like, "Okay guys, now you can just use it in all patients?" Is there really a heavy lift to educate and drive utilization? Well, the good news is, as it relates to the sort of the healthcare ecosystem of the patient, it's still it's the same for standard surgical risk. They go to the doctor, they get diagnosed, they get CT images, they get duplex ultrasound, they get angios. The workup is the same. There's nothing different they have to do for identifying a standard surgical risk patient versus high surgical risk. That is that took a lot of sand out of the gears, too, because they don't have to do anything new. But there is an education. We have a very high clinical consultative selling process in which we get very involved in patient triage, patient selection. We work with them on all the different sharing of images to determine if the patient's a candidate. We build case plans. We execute the case plan. We work very closely with the physician across that whole pre, peri, and postoperative sort of care of the patient. We're heavily involved. We have a sort of a theory that if we can get involved in that whole patient sort of diagnosis and determining if they're a candidate on the front end, then we can continue to educate them on whether the patient is a candidate, and then obviously, convince them that TCAR is the best treatment algorithm for them. As Erica mentioned, patients deserve that choice versus just, you know, just a hammer. Now they have a full tool set. Let's talk about market growth, 'cause COVID really did impact carotid artery treatment, and a lot of these patients were getting diagnosed in conjunction with other procedures. As other procedures came down, carotid artery disease diagnosis came down as well. What are you seeing in terms of returning to normal market growth? I guess normal is different now than maybe it used to be, but let's call it stabilization. Go for it. Yeah. Well, let him just talk. The headwinds of in COVID periods manifest in patients not accessing healthcare, right? Whether they should be screened or diagnosed or treated. We certainly saw that. This, what's interesting in our investor deck is 2021 data around diagnoses and procedures, which is roughly similar to 2019 data. Okay. Which tells you that even in a COVID-dampened year, the demographics of this disease outweighed the headwinds of COVID. Even with patients not fully accessing the healthcare, either it was temporal and they came back, you know, they missed it one quarter, they came back another quarter, or just, look, we're in a aging of the population. All the drivers of cardiovascular disease in general, obesity and sugar and smoking and sitting, we're doing some of those things right now. Aging. Yeah. I'm aging every minute. Yep. You know, are tailwinds to this disease state over time. We, you know, our growth comes from converting CEA, you know, now and in the long term. It also comes from expanding the aperture of treatment, and it comes from the natural tailwind of there should be more screening, more diagnoses, and more treatment as a function of the demographics of the patient population. If I look at, I believe it's on one of your slides, it's something like a billion-dollar-plus addressable market. Those are patients that are treated today. There is something like a billion plus on the other side of the pie chart that are diagnosed but not treated. Have you seen any movement from one to the other? I know there's always been a little bit of movement, are you starting to see any change in trend line with TCAR adoption? Robbie, we haven't turned our attention specifically to that aspect of market expansion. We do know anecdotally, physicians tell us they're treating patients they would not otherwise have done a CEA on. Those are generally in the category of the more sick, the more frail patient, and when you have a minimally invasive option, you can treat more patients that look like that. Here's the interesting disconnect and one that we share with our clinicians all the time, which is there are about a 250, 000 strokes every year in the United States from carotid artery disease, only. A 250, 000. You just said we're treating 170,000, 430,000 are diagnosed. There's obviously a disconnect in who's getting treated and who, and whom are we preventing a stroke. I think, Robbie, we will get to the point where we're focused on market expansion and we're focused on driving that story of, you know, bringing more patients in to be treated. What we do now is focus on reducing the upfront morbidity and mortality. As you've seen from the data, we are achieving that goal. We are reducing the risk of heart attack or cranial nerve injury. We are reducing the time back to work, all of the things that could lead in the future to opening that aperture. We've certainly seen that in every other open to endo conversion story. Whether you're talking about peripheral artery disease, coronary, TAVR, wherever, there is always a market expansion effect when you reduce the upfront tax of doing business. Maybe I'll pause. Any questions in the room? All right, I'll keep going. Recently got Japan reimbursement. Mm-hmm. -for, TCAR. How do we think about, I guess two parts, Japan, the commercial launch uptake in that country, and then just your international strategy in general? Sure. Just to be clear, we received Japan Shonin approval, regulatory approval on both the stents. Apologies. No, no, all good. The flow reversal system. You're right. There are three more steps that have to be accomplished, and they are interrelated. One is reimbursement. Two is really firmly establishing the distribution channel, the go-to-market strategy. Number three is a requirement to do a post-market study. The three of those things are interrelated, and we're working on them, and as soon as we have real clear picture as to what that looks like, we'll reveal the strategy. We've been very clear to say that Japan will not contribute on the revenue line in 2023. Consider this a more longer-term growth driver. What's interesting about Japan is it's a relatively smaller market, to be honest. It's strategically interesting because in Japan, it's neurosurgeons that treat this disease by and large. Having a country trained up of neurosurgeons who perform transcarotid procedures is a nice setup to the things that we're working on in our long-term pipeline, which are, of course, devices and procedures north of the carotid artery, namely acute ischemic stroke and other things. We like the confluence of what could happen in Japan, you know, way down the road. First step, of course, is to launch TCAR and get that firmly established in Japan, and we'll come back to you with more details on that. It's a good segue into maybe talking about the pipeline. Mm-hmm. Beyond carotid, you've started a trial in stroke. Mm-hmm. You have IP around some other access routes, or same access route for different indications, TAVR potentially. Maybe give us the latest update on where you stand on enrolling the stroke trial. Right. You know, Robbie, we're I'm not gonna give any sort of inter-quarter commentary. We'll reserve the right to talk more about the NIGHT 1 study at the earnings call. NIGHT, just to refresh your memory, is Neuroprotection in Transcarotid Embolectomy. That's the acronym NIGHT. Really, NIGHT is a feasibility study. This is the very much crawl, walk, run. This is the crawl stage of the path to acute ischemic stroke. We're really asking two questions in this study. What is the role and the potential benefit or the potential downside of transcarotid access and flow reversal in the setting of acute stroke thrombectomy? Keep in mind, this is the 1st time ever in the world in humans that this has been done. As such, the FDA and we are extraordinarily conservative around who and how we're conducting this trial. The inclusion, exclusion are very narrow and tight. Nonetheless, we've made good progress. In fact, we set some internal goals for ourselves in 2022 relative to NIGHT, and we hit those goals. The good news is we're learning, and that is what we came here to do, so that we can then decide what do we do next with what we're learning. You know, suffice to say that we continue enrollment, which is a good sign. Stroke is a very competitive market right now. Yes. With a lot of players and, you know, if I think about your revenue per procedure today, and I think about, let's call it the cost of the devices in a stroke procedure today, they're not far off from each other. Mm-hmm. potentially doubling. The cost of a stroke procedure require really good outcomes to justify the higher cost, I would imagine. Down the road in your crawl, walk, run scenario, in walk or run, are there gonna be, if it does work, and it works well, are there gonna be some cost economic benefit to show the outcomes, or do you think results would be enough? Yeah. I feel like that's getting way ahead of ourselves. First and foremost, we haven't talked at all about pricing strategies or the economics of what we might do in stroke and not do in stroke. The basic principle is at Silk Road, we have a philosophy, which is we don't do anything unless it's worthy of doing. Why do we think it's worthy of doing? When we look at all the progress that's been made in acute ischemic stroke, a lot of work by colleagues that we really respect has been done there, yet, less than 50% of the patients do well clinically after a successful stroke thrombectomy. There are lots of reasons why that is. It's emboli in new territory. It's dwell time in the vessel. It's multiple passes that lead to bad outcomes. All of those things potentially get better when you start 8 inch-4 inch from the scene of the crime versus 4 ft from the scene of the crime. Mm-hmm. There are a lot of efficiencies built in in the access point in by itself. Flow reversal, you know, is an interesting one. If you think about you've hooked a fish in a river, and you're pulling that fish against the current, there's a probability that that fish comes off of your line. If you reel that fish in with the current, you have a higher chance of the fish staying on the line. Without getting ahead of ourselves, those are the hypotheses that we're thinking about. Great. Maybe Lucas, as we look down the P&L, you've been doing a better job leveraging expenses versus sales. You still have a lot of growth objectives going forward. Top line's growing nicely. you know, you have the launch of standard risk to support here. How should we think directionally about spending going forward? Sure. Well, the last five or six years that Erica articulated building this business, this team and the management team has always had real conviction that TCAR could and should become the standard of care one day. We've been investing towards that vision. We're sitting here at only 11%, but because of the investments and spending we've done to date, we're built for growth, right? We're now built to support a much higher penetration level, a much higher unit volume, much higher revenue line. And that's been a lot of building of the commercial team, the office space, the manufacturing capacity, all of the employee hiring we've done. We're at a great spot entering 2023, where we've got critical mass everywhere. We see a future of driving high revenue growth durably through the adoption curve, that's growth through already trained physicians with a mountain of clinical evidence and experience and a critical mass of a commercial team, plenty of manufacturing capacity now, a fully built out G&A and R&D team. OpEx should grow, you know, certainly slower. Even though we're still leaning into the investment in the business, it's gonna be, you know, we're gonna start to see the growth rate of OpEx versus revenue start to spread and get that operating leverage. Have you provided any targets or rough areas where you think if you hit X in revenue, we should be break even on cash flow or earnings? It's certainly an active discussion internally about how best to give investors some visibility and some confidence. We feel very confident in the balance sheet, in the business model, and our ability to get there. Exactly how we articulate it is something we're thinking about. We have a lot of data to look at around the adoption curve in high surgical risk patients through the noise of a pandemic. We have one quarter publicly and one quarter privately of standard surgical risk adoption curve impact to stare at. We wanna see how that goes. I mean, now that we have over 2,400 physicians trained, you know, tiny improvements in the adoption curve have big impact. That's what we're all kinda staring at. We feel great about our ability to get there. One common theme we've heard so far this week is on price and better pricing in med tech. Not necessarily good, but better. Silk Road's a little unique in that you're the only player in your category. How should we think about price maybe historically for Silk Road, and then any changes you expect going forward? Erica showed the four products, and soon to be a fifth heading into full market release, that make up a TCAR procedure. At the product level, ASPs historically have been flat to slightly up. Andy's team does a great job getting price and defending price because this is a very profitable procedure. It's a very high throughput procedure relative to what they've been doing for now 70 years. There's a real economic value proposition. As well, there's not TCAR company B, C, and D competing with us, which. Those two things, hospitals losing money and high co-competitive intensity are what lead to price decay, and we're not experiencing those. You know, we always like to say everybody gets to win, right? There's a clinical value proposition that is convincing physicians. There's an economic value proposition that's convincing hospital administrators. There's obviously a very compelling patient value proposition. Great. Any last questions? Sure. In terms of utilization, like, procedures per physician, can you compare the sort of lower earlier cohorts to the higher performing cohorts and what you can do to move the earlier up to the higher performing cohorts and move the higher performing cohorts even higher? Right. Well, 1st of all, as it relates to procedures per physician, it's important to remember that everybody starts at zero. From TCAR training day ground zero, it's zero procedures per physician. As we have trained physicians, at a very robust clip over the last five years, we have kind of continuously diluted the denominator of trained physicians. When we look at them as a complete cohort, it's difficult to see the growth that you wanna see. However, the last four quarters in a row, ending in Q3 of 2022, we've seen growth in the overall procedures per physician per quarter. That's a really strong sign that everybody's moving up and to the right. We know about two things really kind of drive physician adoption, accelerate physician adoption. First and foremost, is time from training. The physicians typically take about 1 year. In the pandemic, we saw that elongate to maybe 1 year and a half to really develop their comfort level, their ability to predict with TCAR. In those phases, those cohorts that are still coming up, that 10-15 cases, which takes them 1 year or 1 year and a half, which is a lot of our trained physicians. Think about all the physicians trained in 2022, and most of them trained in 2021, and some of them trained in 2020, are still on that journey. They're gonna stay in the lane of treating patients in whom they really don't wanna do a CEA. That's where they're gaining their comfort and their ability to predict an outcome. It's the physicians that are beyond that 15th case where we see this steeper ramp in adoption. What's interesting, what Andy's group will tell you, is that when we look at physicians who are well up the adoption curve and partially up the adoption curve, they're in that kind of 50% and above utilization, we get more juice for the squeeze out of pushing on those docs than we do on the cohort that are still in that learning phase. We know how to increase adoption, drive adoption, and it happens in that, you know, group of physicians that are well up the adoption curve. Great. With that... Oh, go ahead. I was just gonna say, we now have, you know, multiple data scientists on our team. I didn't even know what a data scientist was a couple years ago. I'm on the healthcare side of Silicon Valley, not the tech side, but we analyze it so many different ways, and that ultimately gets factored into our guidance. Mm-hmm. Great. Well, we're out of time. Thanks so much for joining. Thanks, Robbie. Thanks for listening. Thank you.