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Penumbra Builds Clinical Support Showing Computer Assistance Can Better Address Clot · Vanguards of Healthcare by Bloomberg Intelligence

• 0:20
  Speaker 1: Welcome to another episode of the Vanguards of Healthcare series.
• 0:23
  Speaker 1: My name is Matt Hendrickson, the medical technology analyst at
• 0:26
  Speaker 1: Bloomberg Intelligence, which is the in house equity research platform
• 0:30
  Speaker 1: of Bloomberg LP. We're pleased to have back with us today,
• 0:33
  Speaker 1: Adam Elssser CEO of Panumbra, a medical device company that
• 0:37
  Speaker 1: is developing differentiated solutions for throm vectamy and embolization, including
• 0:42
  Speaker 1: Computer Assistant Vacuum throm Vectamy or CAVT for short. You
• 0:47
  Speaker 1: can dive deeper into the company and its financials by
• 0:50
  Speaker 1: typing in PE and equity go on your Bloomberg terminal. Adam,
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  Speaker 1: thank you for joining us again.
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  Speaker 2: Yeah, thanks Matt for having me appreciate it. Yeah.
• 0:59
  Speaker 1: And so you know, we had you on about eighteen
• 1:02
  Speaker 1: months ago covering the same topics of CABT, and you
• 1:06
  Speaker 1: were talking some about some new products coming out in
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  Speaker 1: twenty twenty five, Lightning twelve, other product, I think there
• 1:13
  Speaker 1: was two or three others. And there was also a
• 1:15
  Speaker 1: correlation with the momentum still in US thrown back to
• 1:18
  Speaker 1: me and in international thrown back to me as well,
• 1:21
  Speaker 1: with the restructuring going on. So maybe why don't we
• 1:24
  Speaker 1: just start for the listeners, just a recap of the
• 1:27
  Speaker 1: last twelve to eighteen months at Penumbra.
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  Speaker 2: And you know how.
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  Speaker 1: CABT is kind of a differentiated technology from some of
• 1:35
  Speaker 1: the other kind of traditional Thronbeck tomy devices out there.
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  Speaker 2: Yeah, thank you, And maybe I'll start by saying, I
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  Speaker 2: think we talked about the work we had ahead of
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  Speaker 2: us for twenty twenty five, you know, could make twenty
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  Speaker 2: twenty five one of the more consequential years you know,
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  Speaker 2: in our history, And what I meant by that is
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  Speaker 2: just the base that we can lay here, the foundation
• 2:01
  Speaker 2: with the innovation we've had, the clinical work we're doing,
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  Speaker 2: could really lay down a strong base for many, many
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  Speaker 2: years of being able to help more and more people
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  Speaker 2: who either suffer from blood clots or some other diseases
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  Speaker 2: where embolization tools matter a lot. So to sort of
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  Speaker 2: then review where we've gotten, you know, during this year,
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  Speaker 2: you're right to call out the launch of a number
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  Speaker 2: of products that you know, yes, Lightning twelve, but the
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  Speaker 2: Lightning Bolt twelve, we also have what we call Lightning
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  Speaker 2: Flash two point zero, which was really the key cornerstone
• 2:41
  Speaker 2: of our PE and DBT business, which was really driving
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  Speaker 2: the growth pretty substantially. That was a second version of
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  Speaker 2: our original Lightning Flash where we changed the software, and
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  Speaker 2: then just on the last earnings call, we announced the
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  Speaker 2: launch of a Lightning Flash three point zero. So we
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  Speaker 2: have made the product better and better and better, and
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  Speaker 2: I can describe some of some of that in a bit.
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  Speaker 2: But between the innovation there on the PE and DVT side,
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  Speaker 2: between some of the structural work we did by bringing
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  Speaker 2: in a new dedicated sales force on the amblization together
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  Speaker 2: with a side, together with new products there, we're really
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  Speaker 2: now in a position where all of our business, both
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  Speaker 2: the ambalyzation business and the thronbectomy business, are in a
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  Speaker 2: position to grow at a relatively similar rate, you know,
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  Speaker 2: over the next number of years. So we're the base
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  Speaker 2: has been laid and now looking forward to twenty six
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  Speaker 2: and beyond, we get to do the work to help
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  Speaker 2: more and more people.
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  Speaker 1: Yeah, and I mean kind of You mentioned the Flash
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  Speaker 1: three point zero because that did catch my attention during
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  Speaker 1: the third quarter call. How does that is that incremental
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  Speaker 1: or you know, more incremental than the two point zero
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  Speaker 1: because you also mentioned it was both the software and
• 4:00
  Speaker 1: a hardware component to.
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  Speaker 2: It, so you know, one of the things that has
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  Speaker 2: allowed us to continue to succeed is just this relentless
• 4:10
  Speaker 2: desire to make our products better and better and better.
• 4:13
  Speaker 2: And I think that that that is an interesting part
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  Speaker 2: of our culture. You know, that's not always true in
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  Speaker 2: some companies. I think where you know, you launch a
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  Speaker 2: product and the team starts talking about how to make
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  Speaker 2: their brand new product already better. You know, I think
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  Speaker 2: sometimes that could have a negative connotation, like, well, why
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  Speaker 2: didn't you make it better the first time? You know,
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  Speaker 2: we we are in a space in which you constantly
• 4:39
  Speaker 2: can make things better and better and better, and we've
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  Speaker 2: never really rested on our laurels or had this sort
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  Speaker 2: of political view that, you know, you can't start looking
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  Speaker 2: for ways to improve it right away. It doesn't mean that,
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  Speaker 2: you know, what we did at the time was the
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  Speaker 2: best technology we can come up with, and then once
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  Speaker 2: we see it in action, how do we make it
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  Speaker 2: better from there? So three, we got a lot of
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  Speaker 2: comments when Flash two point zero launched because people said,
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  Speaker 2: what you just said, Oh, you know, it's just an
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  Speaker 2: incremental change. And the difference is, yes, it was. It
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  Speaker 2: was a software update, but that software update allowed us
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  Speaker 2: to do two fundamental things. Cut the case time almost
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  Speaker 2: in half and see a dramatically less blood loss in
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  Speaker 2: those patients. So it was incremental in that it was
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  Speaker 2: the same functioning product, but it did two things that
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  Speaker 2: mattered a lot, and three point zero does that again. Now,
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  Speaker 2: how do we affect it with three point zero? We
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  Speaker 2: did have a hardware change as well, and we have
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  Speaker 2: a product family called the Bolt family, which uses modulated aspiration.
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  Speaker 2: That product has the in effect that the controls of
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  Speaker 2: the computer and the valve that open and close in
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  Speaker 2: a box halfway down the two big that connects to
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  Speaker 2: the catheter, so not all the way back at the
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  Speaker 2: pump itself, so it's much closer physically to the tip
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  Speaker 2: of the catheter. And so when the control the valve
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  Speaker 2: is opening and closing, the fidelity in which it opens
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  Speaker 2: and closes can be faster and more sensitive if you will,
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  Speaker 2: because you're that much closer to where you want the pressure,
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  Speaker 2: if you will, to change at the tip of the
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  Speaker 2: catheter by opening closing valve. So we moved that technology
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  Speaker 2: or that we use that for flash as well, not
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  Speaker 2: just for the Bold technology. So we have the ability
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  Speaker 2: to have much greater fidelity in the way that works.
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  Speaker 2: And of course with that comes to software change. So
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  Speaker 2: it's early days, but we're really pretty excited about the
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  Speaker 2: idea that we can cut our case times timing wise
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  Speaker 2: further and even less blood loss. And we're seeing that
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  Speaker 2: obviously in early cases. So you know, with pulmonary emolysm
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  Speaker 2: that's PE for you know, say that sword. It just
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  Speaker 2: allows you for the most important part, which is get in,
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  Speaker 2: get the cloud out safely, and move on.
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  Speaker 1: So yeah, and so well, first I just want to
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  Speaker 1: it's interesting that you talk about the iterations and being
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  Speaker 1: able to you know, get a product out there, because
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  Speaker 1: you're right, you could tinker with the certain you know,
• 7:19
  Speaker 1: you could tinker with four point h, which if I'm
• 7:22
  Speaker 1: a betting man, I'm sure you're already starting to do
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  Speaker 1: work on four point h.
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  Speaker 2: You see on the list.
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  Speaker 1: Yes, yeah, but it's something where, like you, you have
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  Speaker 1: to find that balance between perfecting something and you know,
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  Speaker 1: also getting a product out into the market to help
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  Speaker 1: the physician, even if it's only you know, so many
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  Speaker 1: things that you're helping out with. Cutting the time in
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  Speaker 1: half is very important as well. But is that something
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  Speaker 1: when you're talking about the PE and the importance of
• 7:50
  Speaker 1: getting there and getting the cloud out as quickly as possible.
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  Speaker 1: Is that the when you're and you were talking about
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  Speaker 1: the procedure time being cut in half, is that the
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  Speaker 1: time of the suction to pull out the embolism or
• 8:03
  Speaker 1: the clot from the pulmonary region.
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  Speaker 2: Yeah, what I'm alluding to is the actual device time
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  Speaker 2: that you're you know, in interventional treatment. No one has
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  Speaker 2: ever said, you know, I really like, you know, the
• 8:18
  Speaker 2: longer I'm in there with the device, the better it's
• 8:20
  Speaker 2: going to be. Obviously, there's an inherent understanding that, you know,
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  Speaker 2: the faster it can get done and move out, the
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  Speaker 2: better it is. So I think that's you know, that's
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  Speaker 2: sort of a baseline with pulmonary embolism, just like with
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  Speaker 2: strokes and some other things where there's an acute moment
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  Speaker 2: usually happening. You know, the patient's not doing well, they're
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  Speaker 2: potentially you know, decompressing on the table. Time matters a lot,
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  Speaker 2: and we you know, we're because of the storm Pe
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  Speaker 2: trial which was announced earlier this year, we have the
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  Speaker 2: data on what that device time is, you know, in
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  Speaker 2: a pretty rigorous randomized study, and it just doesn't compare
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  Speaker 2: to anything else out there. It's dramatically less so a
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  Speaker 2: couple of things. One time does tend to correlate to success.
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  Speaker 2: And if you're going to now start to do a
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  Speaker 2: lot more cases because there's randomized data saying that this
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  Speaker 2: should be what we do with these patients, you're going
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  Speaker 2: to need to not spend an hour and a half
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  Speaker 2: when you can spend twenty minutes or fifteen minutes. You know,
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  Speaker 2: you just there's no dynamic where that makes any sense.
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  Speaker 2: You can't get it all done. You can't treat all
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  Speaker 2: the patients that are available.
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  Speaker 1: Yeah, and it's actually interesting because you know you're thinking
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  Speaker 1: about limiting blood loss. I mean, is the technology kind
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  Speaker 1: of a compounding effect where the technology itself limits the
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  Speaker 1: blood loss per minute. But it's also because it's a
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  Speaker 1: shorter procedure, it just overall the wer.
• 9:58
  Speaker 2: Both I think you've got that right. Both irrelevant. But again,
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  Speaker 2: the fidelity or the sensitivity of the valve opening closing.
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  Speaker 2: If it can be doing it much faster, that means
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  Speaker 2: the valve is open and you're sucking out clot only
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  Speaker 2: when you're in clot and the moment it doesn't, it
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  Speaker 2: can shut off that much faster, And every sort of
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  Speaker 2: second matters in terms of what's happening at the tip
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  Speaker 2: of the cathere. Yeah.
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  Speaker 1: And then you know, we just talked about the storm
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  Speaker 1: PE trial. Let's just jump into that because it is
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  Speaker 1: very important because your technology is approved already for PE cases.
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  Speaker 1: But this was also the first in a while of
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  Speaker 1: a randomized trial for comparing an interventional technology with you know,
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  Speaker 1: anti coagulation or the traditional standard of care. So why
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  Speaker 1: was the randomized trial in this case so important for
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  Speaker 1: penumber So there.
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  Speaker 2: Was a study done in published in Lancet in nineteen
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  Speaker 2: sixty that established I think it was somewhere around seventy
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  Speaker 2: some odd patients published in Lancet, which is a major
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  Speaker 2: medical journal, that established the standard of care in the
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  Speaker 2: first place, that said, you know, if you have pulmonary
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  Speaker 2: embolism or PE, anti coregulation is better than doing nothing
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  Speaker 2: at all. And that has stayed this standard for quite
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  Speaker 2: a while obviously.
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  Speaker 1: And you said nineteen sixty right, yes, okay, And so
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  Speaker 1: as technologies come onto the market and then gotten better
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  Speaker 1: and better, it was a necessary part of clinical science.
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  Speaker 2: To show that we could you know, that if you're
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  Speaker 2: going to do a mechanical solution, it had to be
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  Speaker 2: better than the standard care, which was anti coagulation, so
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  Speaker 2: that was the point of the study. The many interventionalists
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  Speaker 2: you know wanted it, but most of it was for
• 12:03
  Speaker 2: the group of physicians who are responsible for these patients,
• 12:07
  Speaker 2: whether it's pomonologists, semathologists, emergency room doctors. You know, they
• 12:13
  Speaker 2: they obviously should and do look at clinical science as
• 12:18
  Speaker 2: the guide to what they should be suggesting and referring
• 12:21
  Speaker 2: their patients for it. So it was fairly an important study.
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  Speaker 2: The study term. You know, we presented the primary endpoint
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  Speaker 2: at TCT this year. I think you were there if
• 12:33
  Speaker 2: I recall, and then the secondary endpoints we were presented,
• 12:39
  Speaker 2: we presented a week later and at another meeting, and
• 12:42
  Speaker 2: then it was published simultaneously in circulation. So it is
• 12:47
  Speaker 2: the first of its kind study obviously since nineteen sixty
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  Speaker 2: with mechanical true mechanical solutions. People have called it, you know,
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  Speaker 2: we didn't coin the term, but you know, a landmark
• 13:01
  Speaker 2: study in the treatment of pulmonary emblysm the reaction to
• 13:05
  Speaker 2: the data, not just the primary endpoint, which obviously is important,
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  Speaker 2: but the secondary endpoints where the study wasn't powered to
• 13:15
  Speaker 2: show superiority. We were just looking to show comparability. The
• 13:19
  Speaker 2: four significant both physiological and functional outcomes were statistically significant
• 13:27
  Speaker 2: in favor of using c ABT. So it it has
• 13:31
  Speaker 2: been broadly you know, lauded and accepted in medical community.
• 13:37
  Speaker 2: And we're only a month and a half in and
• 13:40
  Speaker 2: it's been really fun to watch that unfold.
• 13:44
  Speaker 1: Yeah, I love to talk dive more into the reaction
• 13:47
  Speaker 1: you're seeing from the medical field, but you know, just
• 13:49
  Speaker 1: kind of grounding the trial itself though, because you talked
• 13:53
  Speaker 1: about the primary endpoint, you talked about the secondary endpoint.
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  Speaker 1: I understand that the primary endpoint was a reduction in
• 14:02
  Speaker 1: the right ventricle, left ventricle, So you know, yeah, yeah, exactly,
• 14:08
  Speaker 1: And so basically let's start with that, and why is
• 14:12
  Speaker 1: that so important of a score or a diagnosis for
• 14:17
  Speaker 1: these PE patients? And then then is there any connection
• 14:21
  Speaker 1: between that reduction in the ratio that you saw with
• 14:25
  Speaker 1: using the number of technology and that improvement in those
• 14:29
  Speaker 1: secondary scores that you saw.
• 14:31
  Speaker 2: Well, they're very much related, you know, And in fact,
• 14:35
  Speaker 2: the co PI in the meeting that the secondary endpoints
• 14:40
  Speaker 2: were presented answered that question. That was really one of
• 14:43
  Speaker 2: the first questions, is you know, the secondary end points
• 14:47
  Speaker 2: and how strong they were in favor of using CBT
• 14:53
  Speaker 2: really was a validation of the use of LBRB ratio
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  Speaker 2: as the primary endpoint, and I I just want to
• 15:00
  Speaker 2: sort of step back for a second. The RBLV ratio
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  Speaker 2: is the determining factor in qualifying or you know, which
• 15:12
  Speaker 2: what type of PE you're having. So you're either having
• 15:16
  Speaker 2: you know, a high it's a high risk PE, you
• 15:19
  Speaker 2: know it's an intermediate risk, low risk, you know, various qualifications.
• 15:24
  Speaker 2: The use of LBRB ratio is the diagnostic tool to
• 15:29
  Speaker 2: determine that. So by definition, we've already said lower ratios
• 15:35
  Speaker 2: mean less risky, so by definition we should be lowering
• 15:40
  Speaker 2: the ratio and that really matters. So that's why it's
• 15:43
  Speaker 2: been somewhat widely accepted in the community. And it's you know,
• 15:48
  Speaker 2: just a well established marker. Obviously, if that's all that
• 15:53
  Speaker 2: was shown and the secondary endpoints had a mixed result,
• 15:58
  Speaker 2: that would cause some discussion, appropriately, but it's not obviously
• 16:03
  Speaker 2: what happened, you know. And if you think about one
• 16:06
  Speaker 2: of the most important functional outcomes there are the six
• 16:11
  Speaker 2: minute walk test. I just wanted to want to put
• 16:14
  Speaker 2: into context the difference between the two arms. So you know,
• 16:19
  Speaker 2: all those patients walked for six minutes and their distance
• 16:24
  Speaker 2: was measured and that sort of gives you a true
• 16:27
  Speaker 2: functional like how are you doing, you know, post this procedure.
• 16:32
  Speaker 2: And if you took the averages between the two arms,
• 16:36
  Speaker 2: the patients who had received CABT walked almost an entire
• 16:41
  Speaker 2: football field longer than the other patients in that six minutes.
• 16:48
  Speaker 2: That's not like, oh it was better by five yards,
• 16:51
  Speaker 2: it was better by ten yards. It was almost an
• 16:55
  Speaker 2: entire football field longer they can walk in that same
• 16:59
  Speaker 2: six minutes. That's a huge difference in functional outcome because
• 17:05
  Speaker 2: in the two arms that was definitely noticed.
• 17:08
  Speaker 1: Yeah, it's interesting to just you know, just talking about
• 17:10
  Speaker 1: that six minute walk. It just it just highlights how
• 17:13
  Speaker 1: debilitating this disease can be, especially because correct me if
• 17:19
  Speaker 1: I'm wrong, But the trial design there was exclusion factor,
• 17:24
  Speaker 1: so it was basically only including intermediate risk patients, not
• 17:28
  Speaker 1: the high risk patients. So those patients are even sicker
• 17:31
  Speaker 1: and can benefit even more from that treatment.
• 17:34
  Speaker 2: Yeah, yeah, there's no question that this will have an
• 17:37
  Speaker 2: effect across a broader range. You know, why would you
• 17:42
  Speaker 2: want to wait, you know, till patients get sicker and
• 17:45
  Speaker 2: sicker before you then treat them and again that's where
• 17:49
  Speaker 2: the safety profile that showed up in the data was
• 17:54
  Speaker 2: particularly noticeable. And one of the things that we've heard
• 17:58
  Speaker 2: more than almost anything was just how one, you know,
• 18:03
  Speaker 2: the physicians who were enrolling only had to have done
• 18:07
  Speaker 2: two cases in advance of enrolling in as studies. So
• 18:12
  Speaker 2: it just shows you how easy lightning flash is to use.
• 18:16
  Speaker 2: That you don't need a lot of experience. We weren't
• 18:19
  Speaker 2: picking people have done already hundreds cases, two cases and
• 18:23
  Speaker 2: you're ready to enroll, which is pretty unusual. And then
• 18:28
  Speaker 2: even with that lack of experience many people had, it
• 18:32
  Speaker 2: showed how incredibly safe it was. And I think that's
• 18:36
  Speaker 2: really really important because the biggest fear is if you're
• 18:39
  Speaker 2: going to do something different interventionally, it has to be No,
• 18:45
  Speaker 2: it can't be less safe. Yeah, you know that would
• 18:48
  Speaker 2: and it turns out, you know, it's extraordinarily safe.
• 18:51
  Speaker 1: Yeah, And so then let's just let's jump into that.
• 18:54
  Speaker 1: You know, we're talking about the initial reaction from the
• 18:57
  Speaker 1: medical field. But this isn't a quick light switch where
• 19:02
  Speaker 1: you turn it on and everyone realizes it and it's
• 19:05
  Speaker 1: you know, everyone just starts adopting it. So how do
• 19:09
  Speaker 1: we go about from this? You know, we got the
• 19:11
  Speaker 1: clinical data. It's been presented in circulation. You know. The
• 19:14
  Speaker 1: other thing too I noticed well at TCT was the
• 19:17
  Speaker 1: partnership with pert or p e r T, which is
• 19:21
  Speaker 1: the Pulmonary Endlism Response Teams. So how did all these
• 19:25
  Speaker 1: kind of triangulate into your new marketing strategy to get
• 19:29
  Speaker 1: out to the hospitals and the physicians to let them
• 19:33
  Speaker 1: aware of this new technology or the technology and how
• 19:37
  Speaker 1: it can be improved the patient's outcomes.
• 19:41
  Speaker 2: Sure, it is a really good question, and we you know,
• 19:45
  Speaker 2: we've done We've been around for a while as a company.
• 19:48
  Speaker 2: You know, we've done this already in the stroke world
• 19:51
  Speaker 2: when the stroke trials came out saying that we should
• 19:54
  Speaker 2: be intervening on many of these stroke patients, and that
• 19:58
  Speaker 2: had a certain effect. Now they're very big differences and
• 20:02
  Speaker 2: that you know, there there's sort of basic structural issues
• 20:07
  Speaker 2: around where the patient shows up, do you have to
• 20:10
  Speaker 2: transfer them? When you're talking about stroke, you really don't
• 20:14
  Speaker 2: have those structural issues with PE. If you go to
• 20:17
  Speaker 2: a hospital, almost everyone has some interventionalists, you know, whether
• 20:22
  Speaker 2: it's an IR or rasterular surgeon or interventional cardiologists. They're
• 20:27
  Speaker 2: already on call. So it's it's a little you have
• 20:30
  Speaker 2: a lot of the barriers already taken down, but you
• 20:33
  Speaker 2: have to change your protocols in the hospital. What happens,
• 20:36
  Speaker 2: you know, the patient comes to the hospital, they're in
• 20:39
  Speaker 2: the er, they're diagnosed with an intermediate high risk PE.
• 20:43
  Speaker 2: What do you do? You know, right now, most of
• 20:46
  Speaker 2: those protocols that you give me anti coagulation, and it's
• 20:49
  Speaker 2: only when people start to really go down, you know,
• 20:53
  Speaker 2: a different path do they intervene on them. But now
• 20:56
  Speaker 2: you know, you have data that says we should do
• 20:59
  Speaker 2: something different, we should do it earlier before they've sort
• 21:03
  Speaker 2: of started to have serious, serious complications or issues. So
• 21:09
  Speaker 2: how do you get to that. You have to go
• 21:10
  Speaker 2: to those you know, get those hospitals to do the
• 21:13
  Speaker 2: work to change their internal protocols. There's obviously information out there,
• 21:19
  Speaker 2: people are talking about it. Sometimes they do it on
• 21:21
  Speaker 2: their own. The PERT Consortium that you alluded to is
• 21:25
  Speaker 2: the only group in the US that is whole mission
• 21:30
  Speaker 2: is pulmonary embolism. And they created this organization society a
• 21:36
  Speaker 2: number of years ago to really empower and sort of
• 21:40
  Speaker 2: create a cross functional team. So that's the Nate. The
• 21:44
  Speaker 2: name is the pe Response team. So it involves interventionalists,
• 21:49
  Speaker 2: it involves pollmonologists, it involves er docs and ematologists and
• 21:53
  Speaker 2: so on, and they're all talking to each other on
• 21:56
  Speaker 2: a regular basis about who and what should be treated.
• 21:59
  Speaker 2: So it's the ones that would start to impact, you know,
• 22:02
  Speaker 2: changing their internal hospital protocols. So that consortium is already
• 22:08
  Speaker 2: starting that dialogue with their member hospitals. They're starting an
• 22:12
  Speaker 2: effort to bring in more members based on this data
• 22:15
  Speaker 2: to sort of okay, now it's time to really really
• 22:19
  Speaker 2: get more serious and professional in places that you know,
• 22:22
  Speaker 2: maybe we're slightly less organized before. So I think it's
• 22:26
  Speaker 2: a really important part of the story is that physicians
• 22:31
  Speaker 2: are the ones doing the work to make sure that
• 22:34
  Speaker 2: their patients are getting the most up to date care.
• 22:37
  Speaker 1: You know, it's kind of interesting that you talked about
• 22:39
  Speaker 1: the you know, the physician point of view there, because
• 22:43
  Speaker 1: you know, one of the things that I've caught my
• 22:45
  Speaker 1: attention in other UH sectors in medtech, you know, coming
• 22:50
  Speaker 1: to mind is just atual fibrillation and the rise of
• 22:53
  Speaker 1: PFA is that doctors are using the clinical data to
• 22:57
  Speaker 1: support their decision to use PFA techno instead of waiting
• 23:01
  Speaker 1: for a major guideline from ACC or AHA or YESC
• 23:07
  Speaker 1: coming out to then publish it because mainly the guidelines,
• 23:11
  Speaker 1: it takes them so long to you know, update their product.
• 23:15
  Speaker 1: I think some of them, if I saw my math correctly,
• 23:18
  Speaker 1: some of those guidelines for PE are over fifteen years
• 23:20
  Speaker 1: old or almost fifteen years old. So is that right
• 23:25
  Speaker 1: analogy as I'm thinking about the PE technology as well
• 23:28
  Speaker 1: as you can just push this these RCT results directly
• 23:32
  Speaker 1: to the doctors to help them change their practice.
• 23:35
  Speaker 2: It's I don't want to say this too broadly because
• 23:39
  Speaker 2: there's always different opinions, but most physicians that I've talked
• 23:43
  Speaker 2: to don't wait till society guidelines tell them what to do.
• 23:50
  Speaker 2: You know, and you have to remember where the guidelines
• 23:53
  Speaker 2: are coming from. There's no one source of sort of guidelines.
• 23:57
  Speaker 2: You know. This is a society of Interventional Radiologists, they'll
• 24:02
  Speaker 2: have a guideline society. You know, the American Heart Association
• 24:05
  Speaker 2: will have a guideline. You know. I'm sure the Vascular
• 24:08
  Speaker 2: Surgeons Society will have a guideline. They're not sort of
• 24:11
  Speaker 2: this one like we have to wait till some society
• 24:16
  Speaker 2: tells us what to do. This is you know, physicians
• 24:19
  Speaker 2: taking information in real time and deciding how to properly
• 24:22
  Speaker 2: treat their patients, and that is done sort of at
• 24:25
  Speaker 2: a hospital by hospital level. What you know, patients are
• 24:29
  Speaker 2: lucky because the work that PERT Consortium has done over
• 24:33
  Speaker 2: the last you know, six seven years is to build
• 24:37
  Speaker 2: these discussions between people within a hospital. So they're not
• 24:41
  Speaker 2: starting fresh with building those relationships. They're already been talking
• 24:46
  Speaker 2: about what to do with these patients and what would
• 24:49
  Speaker 2: be the best treatment, and so being able to now
• 24:52
  Speaker 2: adapt to new information. In this case, the data from
• 24:56
  Speaker 2: storm should be a more efficient process. And that's how
• 25:01
  Speaker 2: you want it to be, you know, you you it
• 25:03
  Speaker 2: would make no sense to, oh, we have more information
• 25:07
  Speaker 2: and we have to wait a year and a half
• 25:08
  Speaker 2: before us, you know, a physician society changes their guidelines
• 25:13
  Speaker 2: before anyone gets the benefit of that new information. That
• 25:17
  Speaker 2: that doesn't make sense to most people.
• 25:20
  Speaker 1: Yeah, no, And I think, yeah, I think that you
• 25:22
  Speaker 1: know exactly, And I think just having that clinical data
• 25:25
  Speaker 1: as your foundation and your support to initial you know,
• 25:28
  Speaker 1: to initialize this campaign is going to be you know,
• 25:31
  Speaker 1: I think critical. The other thing too, though, is you know,
• 25:34
  Speaker 1: we kind of talked about the high risk patients those
• 25:37
  Speaker 1: who are too sick for the trial, they could potentially benefit. Well,
• 25:42
  Speaker 1: first off, I'll start with them.
• 25:44
  Speaker 2: You're not saying yeah, no, one is saying don't treat
• 25:47
  Speaker 2: those patients now, Yeah, yeah, exactly.
• 25:50
  Speaker 1: But now you're able to show this data with the
• 25:52
  Speaker 1: intermediate risk and saying that although these patients were unsuitable
• 25:55
  Speaker 1: for the trial because of the trial design, they can
• 25:58
  Speaker 1: benefit from this as well, because because you know, if
• 26:00
  Speaker 1: the intermediate is benefiting from it, the sicker patient should
• 26:03
  Speaker 1: be able to better.
• 26:03
  Speaker 2: You sort of get those anyway.
• 26:06
  Speaker 1: What about the other end of the spectrum, What about
• 26:08
  Speaker 1: those low risk patients because some of the indicators, the markers,
• 26:12
  Speaker 1: you don't need that RV dysfunction or that RVLV ratio
• 26:16
  Speaker 1: to get to a certain level. Maybe I'm jumping the
• 26:20
  Speaker 1: gun here, but how do you approach that end of
• 26:23
  Speaker 1: the spectrum of PE patients because although they're asymptomatic, it
• 26:27
  Speaker 1: could still be damaging the lungs to a point where
• 26:29
  Speaker 1: it becomes asymptomatic.
• 26:32
  Speaker 2: Yeah. So that's the open question right now, and I
• 26:36
  Speaker 2: have heard lots of discussion around that topic. So I
• 26:41
  Speaker 2: think it's a little premature to sort of have you
• 26:44
  Speaker 2: a strong thought on it. But but if you just
• 26:49
  Speaker 2: use sort of most basic common sense. So let's say
• 26:54
  Speaker 2: I have a PE and it's a low risk PE,
• 26:57
  Speaker 2: and I go in and I'm given anti coagulation given
• 27:01
  Speaker 2: the safety profile of our product, which has now been shown.
• 27:05
  Speaker 2: If I was given the choice, wouldn't I rather just
• 27:09
  Speaker 2: have the clot taken out now? Because a certain percentage
• 27:15
  Speaker 2: and it's not one or two percent of those patients develop,
• 27:19
  Speaker 2: you know, the clot continues to form, and it transfers
• 27:23
  Speaker 2: from a low risk to an intermediate risk and then
• 27:26
  Speaker 2: potentially to a high risk. Do I want to just
• 27:29
  Speaker 2: sit there waiting for that or do I want Look,
• 27:32
  Speaker 2: it's shown that it's no difference in safety, just get
• 27:38
  Speaker 2: the clot out.
• 27:38
  Speaker 1: Yep.
• 27:40
  Speaker 2: And I think one could make that argument. I think
• 27:43
  Speaker 2: it's a little bit premature, you know, for me to
• 27:48
  Speaker 2: be making those statements, but just logic tells you, you know,
• 27:52
  Speaker 2: those are the conversations people will start to have.
• 27:55
  Speaker 1: Yeah, and it's kind of I mean, that's the thing
• 27:58
  Speaker 1: is that if you can convince support the thesis that and.
• 28:02
  Speaker 2: We're showing you know, some of the you had mentioned
• 28:04
  Speaker 2: stride you know, or you know, strike and that some
• 28:08
  Speaker 2: of the other studies. I get all the various ones
• 28:11
  Speaker 2: we're doing. Some of that's showing that in intermediate low
• 28:14
  Speaker 2: it won't be a randomized trial, but it will start
• 28:16
  Speaker 2: to show and confirm the safety data as well, So
• 28:20
  Speaker 2: you know, more to come over time. But you know,
• 28:23
  Speaker 2: logic tells you you know.
• 28:26
  Speaker 1: Yeah, it's like treating cancer and stage one set waiting
• 28:29
  Speaker 1: for stage four.
• 28:30
  Speaker 2: Yeah. I think that's a fairly you know, it's an
• 28:33
  Speaker 2: analogy I've not heard, but yes, I think it's fair.
• 28:37
  Speaker 1: Yeah, And so I mean, but also, I mean, I
• 28:40
  Speaker 1: don't know who designs the clinical trial names, but someone
• 28:42
  Speaker 1: loves the st at the start of your trial names.
• 28:46
  Speaker 1: We can dive into that if we want. But also,
• 28:48
  Speaker 1: but you know, you talked about strike PE, which that
• 28:51
  Speaker 1: is the single arm trial. That's you know, it's but
• 28:55
  Speaker 1: it let's start with that. How should I look at
• 28:57
  Speaker 1: that strike PE data because it is just as compelling
• 29:02
  Speaker 1: single arm study versus the randomized trial that you're doing
• 29:05
  Speaker 1: or with the storm.
• 29:07
  Speaker 2: I think it all just adds to the body of
• 29:09
  Speaker 2: evidence around safety time and ultimately are we just getting
• 29:14
  Speaker 2: the clout out? You know, And I think the randomized
• 29:18
  Speaker 2: was critical, but the rest of it just bolsters that
• 29:21
  Speaker 2: as it expands out the number of patients and the
• 29:24
  Speaker 2: type of patients we're treating.
• 29:25
  Speaker 1: Yeah, and actually, let me just I'm curious because the
• 29:28
  Speaker 1: interesting about strike PE is that you're presenting it on
• 29:31
  Speaker 1: an interim basis, and so as you continue to enroll,
• 29:35
  Speaker 1: you're also now starting to implement flash three point oh
• 29:39
  Speaker 1: potentially in there. So is that something maybe where that
• 29:42
  Speaker 1: the new cohortive patients being enrolled now are being able
• 29:47
  Speaker 1: to show the benefits of three point zero versus the
• 29:49
  Speaker 1: legacy technology.
• 29:51
  Speaker 2: Yeah, I mean we're we're weeks into launching that product,
• 29:56
  Speaker 2: so you know, I don't want to get too far
• 29:58
  Speaker 2: ahead of ourselves on how many will get into the
• 30:01
  Speaker 2: trial and all that, but yeah, the goal is to
• 30:04
  Speaker 2: continue to add to the clinical evidence, and time of
• 30:09
  Speaker 2: procedure is really really an important part of it. So yeah,
• 30:14
  Speaker 2: I think we'll have the capacity going forward, you know,
• 30:18
  Speaker 2: not immediately because we're just launching it, but to look
• 30:21
  Speaker 2: back and get that information on three point zero and
• 30:25
  Speaker 2: how much better and faster it is. It's been fun.
• 30:28
  Speaker 2: You know. At this point we're just dealing with anecdotal information.
• 30:32
  Speaker 2: You know, Wow, I did a case, you know, device
• 30:36
  Speaker 2: time was ten minutes, you know, that kind of thing,
• 30:39
  Speaker 2: which is amazing, But we have to wait till we
• 30:42
  Speaker 2: have a little more than just case anecdotes too, you know, yeah,
• 30:47
  Speaker 2: a little more, but yeah, the early case anecdotes are amazing.
• 30:52
  Speaker 1: Yeah, it just you know, just continues to build on
• 30:54
  Speaker 1: the clinical support. Yeah, you know with strike PE, but
• 30:59
  Speaker 1: you're also doing these additional studies for other areas of
• 31:05
  Speaker 1: you know, in the body to remove clot, including the
• 31:07
  Speaker 1: stride to and the BOLT trials. Now, I don't we
• 31:12
  Speaker 1: don't need to get into the nitty gritty of each
• 31:14
  Speaker 1: of these trial designs, but what is the strategy about
• 31:17
  Speaker 1: continuing to build this data and build this foundation of
• 31:21
  Speaker 1: clinical support for using CAV technology.
• 31:26
  Speaker 2: Yeah, they're really an attempt to gather real world evidence
• 31:30
  Speaker 2: around how well our products are working in those areas.
• 31:35
  Speaker 2: You know, in stride we're dealing with on the arterial side,
• 31:39
  Speaker 2: you know, the the standard of care is either open
• 31:44
  Speaker 2: surgery or you know, a cathod directed license dripping litick,
• 31:49
  Speaker 2: and so we're really trying to get information as to okay,
• 31:53
  Speaker 2: what is better doing it this way? You know, how
• 31:56
  Speaker 2: much faster, how much more clout do we get out?
• 31:59
  Speaker 2: You know, you know, there's some work we're doing independent
• 32:03
  Speaker 2: of STRIDE that it looks at the health economics of it,
• 32:08
  Speaker 2: which is important. So that's and BOLT is the same
• 32:13
  Speaker 2: thing where we're really looking at, you know, how these
• 32:16
  Speaker 2: patients are getting treated. DVT is an interesting one that
• 32:19
  Speaker 2: because not in all cases, but in some cases, you know,
• 32:23
  Speaker 2: a DVT that's untreated, if you will, could turn into
• 32:28
  Speaker 2: a pulmonary amblysm a PE, and and so that that
• 32:33
  Speaker 2: is there are early conversations amongst physicians about you know,
• 32:38
  Speaker 2: now that we want to treat more of than and PE.
• 32:41
  Speaker 2: You know, should we start to look at DVT differently.
• 32:46
  Speaker 2: You know, again we're we're not leading those conversations. Obviously,
• 32:51
  Speaker 2: physicians are sharing that amongst themselves and they will be
• 32:54
  Speaker 2: interesting to watch how that turns out.
• 32:57
  Speaker 1: Yeah, and I just kind of, like I said, it's
• 32:59
  Speaker 1: just continuing to build that clinical support for what you know,
• 33:02
  Speaker 1: c av T can do. I feel like we can
• 33:06
  Speaker 1: go on for hours about this, but yeah, I mean,
• 33:09
  Speaker 1: there's just so many other parts of your company that
• 33:11
  Speaker 1: you know, just had a couple updates on. One of
• 33:13
  Speaker 1: them is actually the emalyization one, and that was interesting
• 33:16
  Speaker 1: you were talking about you know, well, one, you launched
• 33:19
  Speaker 1: the Ruby xcel coils. You also then highlighted earlier in
• 33:25
  Speaker 1: this conversation about the new sales force and so you know,
• 33:30
  Speaker 1: having an independent salesforce for both from victimy and embolization.
• 33:35
  Speaker 2: What was the.
• 33:38
  Speaker 1: How did you go about that decision making process? Because
• 33:41
  Speaker 1: that's a huge you know investment both of capital and
• 33:45
  Speaker 1: time to make sure you get these you know, the
• 33:47
  Speaker 1: new team up and running. So what how how did
• 33:51
  Speaker 1: you look at that as the opportunity and this was
• 33:54
  Speaker 1: the right time to make that investment.
• 33:57
  Speaker 2: Well, so yeah, let me just clarify to make sure.
• 34:03
  Speaker 2: So the the adding of a sales embolization salesforce happened
• 34:09
  Speaker 2: on our peripheral vascular side, not on the neuroside. That
• 34:13
  Speaker 2: they're staying focused on both products are now the field
• 34:17
  Speaker 2: is much smaller, less customers to call on. So so far,
• 34:22
  Speaker 2: we're going to keep it that way. Now, we'll watch it.
• 34:24
  Speaker 2: There's a lot of talk and excitement on our EMBO
• 34:29
  Speaker 2: our emberlization tools in neuro having some outside growth now
• 34:34
  Speaker 2: with embolizing the mm A middle manager artery, so that
• 34:41
  Speaker 2: could be a huge growth driver coming up that you know,
• 34:44
  Speaker 2: we'll assess that. But for now, I think we're in
• 34:46
  Speaker 2: good shape with the neuroside, but on the vascular side,
• 34:51
  Speaker 2: we just had too much to do. And there's you know,
• 34:54
  Speaker 2: the reps just had you know, we've already hired enough
• 34:58
  Speaker 2: people that the account number, the number of accounts were
• 35:01
  Speaker 2: more manageable, but they had a whole franchise on EMBO
• 35:06
  Speaker 2: and a whole franchise on to ourbectomy, and it was
• 35:09
  Speaker 2: just clear that it was one side of that was
• 35:12
  Speaker 2: going to suffer, you know, and we didn't want that
• 35:17
  Speaker 2: to happen. Our embolization franchise is uniquely good. The design
• 35:23
  Speaker 2: of our products are different than others. They're known for
• 35:29
  Speaker 2: being sort of bigger diameter, softer, longer, you know, sort
• 35:34
  Speaker 2: of filling space much easier than traditional coils. And so
• 35:39
  Speaker 2: because of that, we wanted to be able to take
• 35:43
  Speaker 2: advantage of even our existing products. And then we had
• 35:47
  Speaker 2: a launch coming and it was sort of like, well,
• 35:49
  Speaker 2: we're just not going to be able to do all this.
• 35:50
  Speaker 2: So we made the decision to hire a team that
• 35:55
  Speaker 2: could slide in same management structure, not a separate division.
• 35:59
  Speaker 2: If you well, and it's worked out extraordinarily, well, I
• 36:04
  Speaker 2: won't lie. I had a lot of anxiety about you know,
• 36:08
  Speaker 2: how one can pull that off without demoralizing you know,
• 36:12
  Speaker 2: some of the people that have done so well to
• 36:15
  Speaker 2: build the business up till now, but are head of
• 36:19
  Speaker 2: the sales organization together with Truthy Ryan, who's recently been
• 36:23
  Speaker 2: promoted to president, they just did an extraordinary job of
• 36:28
  Speaker 2: setting this up, navigating it, communicating it, and it really
• 36:32
  Speaker 2: has been somewhat seamless. So we I think surprised a
• 36:37
  Speaker 2: lot of people last quarter with the growth we saw
• 36:40
  Speaker 2: in our embolization franchise. And then you know, which is
• 36:45
  Speaker 2: not solely related to a new product. It was partly
• 36:49
  Speaker 2: related to a new product, but that was we obviously
• 36:52
  Speaker 2: didn't penetrate the whole market with a new product in
• 36:56
  Speaker 2: one quarter, so there's a lot more to go. But
• 36:58
  Speaker 2: also just the folks has really reinvigorated that franchise and
• 37:05
  Speaker 2: it's pretty clear that's not going to stop anytime soon.
• 37:08
  Speaker 1: Yeah, and you know there, yeah, you had that as well.
• 37:11
  Speaker 1: And then you know, one of the things that seems
• 37:14
  Speaker 1: highly anticipated, at least in the investment side, is the
• 37:18
  Speaker 1: pending launch of Thunderbolt, which is going to you know,
• 37:21
  Speaker 1: when it comes out, it will introduce c a VT
• 37:24
  Speaker 1: to schemic stroke treatment. How can that technology disrupt the
• 37:31
  Speaker 1: current stroke treatment options.
• 37:34
  Speaker 2: Well, so, if you go back and look at the
• 37:38
  Speaker 2: history of innovation and stroke, we started the whole idea
• 37:44
  Speaker 2: of aspiating clot in the stroke market, you know, long
• 37:48
  Speaker 2: before we had our peripheral business in PE or arterial DVT,
• 37:53
  Speaker 2: and the idea was simple. You know, they are really
• 37:55
  Speaker 2: only two ways to remove clot. You either take some
• 37:59
  Speaker 2: device that can hold on to it and drag it
• 38:02
  Speaker 2: out of the vessel, or you in effect suck it out,
• 38:06
  Speaker 2: you know, aspirate it out. You know, it's the more
• 38:09
  Speaker 2: formal term. Those are really the only two methods. You know.
• 38:12
  Speaker 2: You can try to dissolve it. That's what drugs do.
• 38:16
  Speaker 2: That had been you know, more of the traditional method.
• 38:19
  Speaker 2: But when you dissolve cloud, you thin the blood. That's
• 38:22
  Speaker 2: how it works, and you have the risk of hemorrhage,
• 38:25
  Speaker 2: which was always hanging over you know, yes, we got
• 38:28
  Speaker 2: the cloud out, but we created a hemorrhage. Is you
• 38:31
  Speaker 2: know that was always this challenging Well.
• 38:34
  Speaker 1: Yeah, it sounds very simmary to what you were just
• 38:36
  Speaker 1: talking about with PE saying like, yeah, we have a
• 38:38
  Speaker 1: new treatment that treats it better. But it's also there's
• 38:41
  Speaker 1: no there's not the you know, you know, there's not
• 38:43
  Speaker 1: the risk of other complications popping exactly.
• 38:45
  Speaker 2: So that was sort of the world of stroke, you know,
• 38:48
  Speaker 2: literally twenty years ago when we started the company. So
• 38:50
  Speaker 2: we created a product at the time. You know, this
• 38:55
  Speaker 2: is again back in two thousand and four when we
• 38:57
  Speaker 2: started the company. The we made a catheter much bigger
• 39:03
  Speaker 2: than any company had made it. Neuro intervention was very
• 39:07
  Speaker 2: small then, you know, very new, not a lot of products,
• 39:10
  Speaker 2: not a lot of companies, and we made a catheter
• 39:13
  Speaker 2: that was had an inner diameter to point oh four
• 39:17
  Speaker 2: to one, and that was considered, wow, that's big to
• 39:22
  Speaker 2: take up into the intracranial you know, anatomy, you know,
• 39:26
  Speaker 2: to what we call them the M one segment, you know.
• 39:31
  Speaker 2: And but we had to redivid design how catheters were
• 39:35
  Speaker 2: made in order to make a catheter soft enough, trackable
• 39:39
  Speaker 2: enough to safely get there. And it worked and we
• 39:43
  Speaker 2: were able through the use of an adjunct tool that
• 39:47
  Speaker 2: helped clear the tip of the catheter to get clought
• 39:50
  Speaker 2: out pretty well. The cases though took a while. I
• 39:56
  Speaker 2: was reminiscing with my co founder doctor Bose recently about
• 39:59
  Speaker 2: the first case ever done. It worked, clot came out,
• 40:05
  Speaker 2: patient had come in. If my memory serves me right,
• 40:08
  Speaker 2: this would have been two thousand and six, so I
• 40:11
  Speaker 2: think my memory is pretty good. But you know, the
• 40:13
  Speaker 2: patient wasn't able to move their right side or talk
• 40:17
  Speaker 2: because of the impacts of their stroke, and on the
• 40:20
  Speaker 2: table they regained those functions after we got the cloud out.
• 40:24
  Speaker 2: It was extraordinary, you know, to have a first case
• 40:27
  Speaker 2: go like that. And I remember asking, well, how long
• 40:30
  Speaker 2: did it take, you know, and he said, oh my god,
• 40:32
  Speaker 2: it was so fast. It took an hour and a half.
• 40:35
  Speaker 2: And an hour and a half. Then was like, oh
• 40:37
  Speaker 2: my god, you know, this is amazing. But obviously, you
• 40:41
  Speaker 2: know that isn't good enough in the long run. So
• 40:45
  Speaker 2: we then made the catheter a little bit bigger because
• 40:48
  Speaker 2: it could shorten the procedure a little because you have
• 40:51
  Speaker 2: more room to suck out the clot. And then we
• 40:54
  Speaker 2: made it a little bit bigger, and then a little
• 40:56
  Speaker 2: bit bigger, and then we but we stopped about five
• 41:00
  Speaker 2: years ago at the size of seven two. Because there's
• 41:06
  Speaker 2: the basic physics of aspiration tell you that if you
• 41:11
  Speaker 2: don't have flow or you have you know, a semi
• 41:16
  Speaker 2: exclusive catheter. Your flow is limited in aspiration, not enhanced.
• 41:23
  Speaker 2: There's a certain size where it's just too big. So
• 41:27
  Speaker 2: we didn't go beyond O seven two and instead we
• 41:30
  Speaker 2: started working on this idea of CABT. It was initially
• 41:34
  Speaker 2: four stroke, so that we could modulate the tip of
• 41:38
  Speaker 2: the aspiration the tip of the catheter and suck out
• 41:42
  Speaker 2: or ingest that clot, you know, in a much higher
• 41:47
  Speaker 2: rate using this method, because just going bigger was going
• 41:51
  Speaker 2: to backfire, and other companies just went bigger. You know,
• 41:55
  Speaker 2: they are now a whole suite of companies with catheters
• 41:58
  Speaker 2: that are big as OE eight. But it's not working
• 42:02
  Speaker 2: that well because the aspir it's almost inclusive or semi inclusive,
• 42:06
  Speaker 2: and it limits the ability of aspiration to work. But
• 42:11
  Speaker 2: that's the how Thunderbolt initially started. We're FDA on the neuroside,
• 42:17
  Speaker 2: wanted us to run a trial. We run that trial.
• 42:20
  Speaker 2: You know now it's under submission. That product. Those those
• 42:23
  Speaker 2: same technologies were able to launch on the perferal side,
• 42:27
  Speaker 2: obviously extraordinary safe. We've done tens and then you know,
• 42:31
  Speaker 2: you know, so many thousands in case of the last
• 42:33
  Speaker 2: five years of that technology, and it really works well
• 42:37
  Speaker 2: to do what I've said. So it's it's been quite
• 42:40
  Speaker 2: the journey, but we're extraordinarily proud of again just looking
• 42:46
  Speaker 2: for more and more technology to deal with the issues
• 42:51
  Speaker 2: of blood clot, whether it's in your brain or your
• 42:53
  Speaker 2: legs or your lungs. In the next phase is going
• 42:55
  Speaker 2: to be more fun because we get to add you know,
• 42:58
  Speaker 2: once you have a computer, in every case, the computer
• 43:02
  Speaker 2: can likely do more than just open and close a valve,
• 43:05
  Speaker 2: you know, in the right their computer can collect all
• 43:09
  Speaker 2: kinds of information. And we'll leave it at that. But
• 43:12
  Speaker 2: that phase is coming and it's gonna be a lot
• 43:14
  Speaker 2: of fun.
• 43:15
  Speaker 1: Yeah, well, it's it's yeah, And you know, I think
• 43:18
  Speaker 1: it's interesting to close out this way because you just
• 43:21
  Speaker 1: said quite a journey. And you know, I remember last
• 43:24
  Speaker 1: episode when you were here. You know, we talked about
• 43:27
  Speaker 1: upcoming up on twenty years, your past twenty years now.
• 43:30
  Speaker 1: You know, we talked about you know, six being the
• 43:32
  Speaker 1: first with stroke and then it took ten years to
• 43:35
  Speaker 1: reach one hundred million in sales. It took only nine
• 43:38
  Speaker 1: years after that did you reach a billion in sales.
• 43:40
  Speaker 1: We talk about you know, the David and Goliath and
• 43:43
  Speaker 1: how you know you were facing off against the large
• 43:46
  Speaker 1: cap medtech teams. Now you know you are in that.
• 43:49
  Speaker 1: You know you're more in that large cap mid cap
• 43:52
  Speaker 1: name yourself fending off private companies. But what really caught
• 43:56
  Speaker 1: my attention last episode was your two pager, which you're
• 44:00
  Speaker 1: showing me this now for those who can't you know,
• 44:03
  Speaker 1: because this is audio only. And you you know, you
• 44:06
  Speaker 1: talked about how it outlines the strategy for the number
• 44:09
  Speaker 1: going into the future, and you know, kind of just
• 44:12
  Speaker 1: throwing all those in together in one bowl and mixing
• 44:15
  Speaker 1: it around. How has those two pagers and strategies evolved,
• 44:20
  Speaker 1: not only the goals that you put in it, but
• 44:23
  Speaker 1: how you organize everything as you've gone from you know,
• 44:27
  Speaker 1: day one, no products, first strokecase, transitioning to the peripheral
• 44:33
  Speaker 1: getting into a billion in sales having CABT technology, how
• 44:37
  Speaker 1: has your approach to that two pager evolved over that time?
• 44:41
  Speaker 2: You know, so the two pager is is more of
• 44:46
  Speaker 2: a function of the last sort of five six years
• 44:50
  Speaker 2: than early days. Early days, we had one product, then
• 44:53
  Speaker 2: we maybe had two. You know, there was no need
• 44:58
  Speaker 2: for writing any of that down. We all knew what
• 45:01
  Speaker 2: the one or two products were interesting. Yeah, you know,
• 45:03
  Speaker 2: maybe we got three, and then as those products were
• 45:08
  Speaker 2: coming to fruition, we'd be sitting around talking about the
• 45:11
  Speaker 2: next thing. You know, there was not enough to think
• 45:17
  Speaker 2: you needed to write it down. We could keep two
• 45:19
  Speaker 2: or three things in our head at once. I hope
• 45:22
  Speaker 2: as the company has grown, and this is not sort
• 45:25
  Speaker 2: of my two pager as much as you know, a
• 45:29
  Speaker 2: small group of us, you know, who look at this
• 45:32
  Speaker 2: on a regular basis. It became clear again over ten
• 45:36
  Speaker 2: years ago that we could easily lose our way if
• 45:40
  Speaker 2: R and D was getting input from all these sources.
• 45:45
  Speaker 1: How do they assess it?
• 45:46
  Speaker 2: Who's deciding what?
• 45:48
  Speaker 1: You know?
• 45:48
  Speaker 2: When you hear, you know, a sales rep have an
• 45:51
  Speaker 2: opinion might be an amazing opinion, might be in reaction
• 45:55
  Speaker 2: to a one off event that happened. How do you
• 45:59
  Speaker 2: think about and assess information from all the sources that
• 46:03
  Speaker 2: you need to to make sure you're working on and
• 46:06
  Speaker 2: improving your products the right way. So we sort of,
• 46:10
  Speaker 2: you know, there's a group of people that have this
• 46:14
  Speaker 2: conversation on a regular basis. It's not formal, you know,
• 46:18
  Speaker 2: we write it down now, these are the products that
• 46:21
  Speaker 2: we're working on, These are the ones that are next up,
• 46:23
  Speaker 2: These are the ones that we're still thinking about, and
• 46:26
  Speaker 2: we change all of that on a fairly regular basis
• 46:29
  Speaker 2: based on what we know, what's changed, what's happened in
• 46:33
  Speaker 2: the marketplace, how are products performing, so that we're constantly
• 46:38
  Speaker 2: able to be working on the right thing and what matters.
• 46:42
  Speaker 2: And again it's rare that you know, we're deep into
• 46:45
  Speaker 2: a product and then we change our mind. You know,
• 46:49
  Speaker 2: occasionally that's happened. I can't remember the last time, but
• 46:52
  Speaker 2: most of the time it's just to prioritize, you know,
• 46:56
  Speaker 2: are just extraordinary R and D team so that they're
• 46:59
  Speaker 2: doing like they know what they should be working on
• 47:02
  Speaker 2: and they're not getting inputs from too many different sources
• 47:07
  Speaker 2: that take them off track. So that's the basis of it,
• 47:12
  Speaker 2: and it's highly effective. What's exciting is since we started
• 47:16
  Speaker 2: doing that, it's never not been two pages long, and
• 47:20
  Speaker 2: I mean two pages of single spaced lists of products
• 47:25
  Speaker 2: that we're either working on or teed up or doing
• 47:28
  Speaker 2: early research on. So we have no shortage of stuff.
• 47:32
  Speaker 2: You know, we're not like, oh God, what do we
• 47:34
  Speaker 2: do next? You know, which I know some people have
• 47:38
  Speaker 2: as internal R and DEEP teams. We do not have that.
• 47:41
  Speaker 2: And it's constantly been fed through just making things better,
• 47:47
  Speaker 2: adding a few tools, that kind of thing.
• 47:50
  Speaker 1: Yeah, and I'm excited to see how the two pages
• 47:53
  Speaker 1: evolves over the next couple of years as we continue
• 47:55
  Speaker 1: to stay in touch. But Adam, thank you so much
• 47:58
  Speaker 1: for joining us today.
• 47:59
  Speaker 2: Yeah, my pleasure enjoyed it.
• 48:00
  Speaker 1: Thank you yea, and thank you to our listeners for
• 48:03
  Speaker 1: tuning in today. We hope you join us for future episodes,
• 48:06
  Speaker 1: and if you'd like to stay up to date, you
• 48:08
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• 48:10
  Speaker 1: streaming platform. Take care,