Silk Road Medical, Inc (SILK) Q4 2022 Earnings Call Transcript

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Silk Road Medical, Inc (NASDAQ:SILK) Q4 2022 Results Conference Call February 28, 2023 4:30 PM ET

Company Participants

Marissa Bych - Investor Relations

Erica Rogers - Chief Executive Officer

Lucas Buchanan - Chief Financial Officer and Chief Operating Officer

Conference Call Participants

Travis Steed - Bank of America Securities

Robbie Marcus - JP Morgan

Adam Maeder - Piper Sandler

Joanne Wuensch - Citi


Good day, and convey you for opinionated by. Welcome to nan Fourth Quarter 2022 Silk Road Medical Conference Call. At this time, each participants are successful a listen-only mode. After nan speakers’ presentation, location will beryllium a question-and-answer session. [Operator Instructions] Please beryllium advised that today’s convention is being recorded.

I would now for illustration to manus nan convention complete to your speaker today, Marissa Bych. Please spell ahead.

Marissa Bych

Thank you for joining today’s call. Joining maine are Erica Rogers, Chief Executive Officer; and Lucas Buchanan, Chief Financial Officer and Chief Operating Officer.

Earlier today, Silk Road Medical released financial results for nan 3 and 12-months ended December 31, 2022. A transcript of nan property merchandise is disposable connected nan Company’s website.

Before we begin, I would for illustration to punctual you that guidance will make statements during this telephone that see forward-looking statements wrong nan meaning of nan Federal Securities Laws, which are made pursuant to nan Safe Harbor provisions of nan Private Securities Litigation Reform Act of 1995. Any statements contained successful this telephone that subordinate to expectations aliases predictions of early events, results aliases capacity are forward-looking statements.

All forward-looking statements including without limitation, those relating to our operating trends and early financial performance, disbursal management, expectations for hiring and maturation successful our statement and our business, expert training and adoption, marketplace opportunity and penetration, commercialized and world description , regulatory approvals, reimbursement, title and merchandise improvement are based upon our existent estimates and various assumptions.

These statements impact worldly risks and uncertainties that could origin existent results aliases events to materially disagree from those anticipated aliases implied by these forward-looking statements. Accordingly, you should not spot undue reliance connected these statements.

For a database and explanation of nan risks and uncertainties associated pinch our business, please mention to nan Risk Factors conception of our quarterly study connected Form 10-Q revenge pinch nan Securities and Exchange Commission connected November 9, 2022.

This convention telephone contains clip delicate accusation and is meticulous only arsenic of nan unrecorded broadcast today, February 28, 2023. Silk Road Medical disclaims immoderate volition aliases responsibility isolated from arsenic required by rule to update aliases revise immoderate financial projections aliases forward-looking statements whether we person nan caller information, early events aliases otherwise.

And pinch that, I will move nan telephone complete to Erica Rogers, Chief Executive Officer.

Erica Rogers

Good day and convey you each for joining us. 2022 closes nan books connected a singular twelvemonth astatine Silk Road, we achieved a full gross of $138.6 million, supported by complete 19,500 procedures representing 37% and 41% year-over-year maturation respectively.

Our capacity was driven by increasing expert take and acceptance of TCAR arsenic nan solution successful minimally invasive changeable prevention. We achieved our full-year territory description expectations and exceeded our trained expert guidance successful consequence to accrued demand.

We besides made important advancement toward our nonsubjective of strengthening Silk Roads class activity successful nan curen of carotid artery disease, pinch nan description of TCARs branded denotation to see patients astatine modular consequence for surgical complications.

The FDA support successful May promptly followed by expanded Medicare sum wrong nan TCAR surveillance task opened our addressable marketplace to nan full 170,000 yearly carotid procedures successful nan United States, while expanding our entree to nan afloat 430,000 yearly U.S. diagnoses, representing a $3.2 cardinal opportunity. Physicians are now capable to simplify curen decisions pinch nan champion liking and penchant of patients astatine nan core.

Our occurrence remains rooted successful nan ample and expanding assemblage of objective grounds and supportive TCAR. In 2002, we surpassed 25,000 patients worthy of objective information from tests and registries published successful precocious effect facet adjacent reviewed aesculapian journals. In fact, we saw complete 85 TCAR publications wrong nan twelvemonth authored by complete 75 distinguished physicians pinch wide scope crossed nan United States.

And we are pleased that nan Society for Vascular Surgery, vascular value initiative, nan SVSV QI dataset continues to turn rapidly. This allows TCAR performing physicians to measure existent world information successful a modern timeframe originated independent of industry.

Adding to our 2022 successes, we bolstered our equilibrium expanse by astir $135 million, paving nan measurement for ongoing finance and maturation arsenic we thrust toward profitability. We besides brought our Minnesota installation online adding manufacturing and distribution capacity, arsenic good arsenic entree to a talented workforce.

We will proceed to prioritize advancements successful U.S. TCARs specifically successful our commercialized team, merchandise R&D, and ongoing objective information specified arsenic ROADSTER 3. Our attraction is connected strategies to heighten our trajectory and meaningfully standard our business overtime.

This brings maine to our 2023 objectives. Number 1 grow. As we displacement our attraction to nan twelvemonth ahead, our first nonsubjective remains accordant driving accrued TCAR utilization done beardown commercialized execution.

We cognize that nan largest opportunity successful beforehand of america is bringing physicians up nan take curve successful nan shape of higher TCAR usage. And we cognize from years of commercialized description that we execute beardown returns connected accrued expert engagement.

That is why passim this twelvemonth we stay focused connected driving much touch-points pinch physicians done territory description and broad trading campaigns. Now, much than ever, we are focused connected highlighting nan diligent benefits of TCAR complete different alternatives.

We will proceed to make grounds to support diligent decision-making and widen our commercialized scope to much diligent centered stakeholders. As we thrust TCAR marketplace penetration from astir 12% successful 2022 to mid-teens complete nan coming twelvemonth and beardown double-digits beyond. We are immensely excited astir nan trajectory up and stay focused connected progressing TCAR toward nan modular of care.

Our 2nd privilege is to fortify nan business. We person spent nan past 5 positive years laying a instauration for maturation successful nan U.S. carotid illness marketplace done our wide portfolio of cardinal halfway products, coagulated commercialized footprint and robust operations.

We are building upon nan spot of this instauration to support our maturation outlook, and further widen our class activity while we thrust operating leverage connected nan way to creating and sustaining a profitable business.

And yet diversify wherever our intentions are twofold. For one, this includes extending our geographic reach. Our extremity has ever been to make TCAR nan modular of attraction for nan curen of carotid artery illness globally. We made meaningful advancement successful 2022 connected this front, receiving shown and approvals successful Japan for some our ENROUTE Neuroprotection System and nan ENROUTE stent.

In summation to preparing for world launches, we will proceed to grow connected our halfway competencies done merchandise innovation. This effort originates wrong carotid artery illness and positions america to grow nan exertion of our class starring exertion beyond.

As portion of our ongoing pursuit of invention successful Transcarotid technologies, we precocious announced nan clearance of our Enflate Transcarotid accelerated speech balloon dilation catheter aliases Enflate for short.

The first balloon intent built for TCAR and nan 5th merchandise successful our TCAR portfolio. We initiated a constricted motorboat of Enflate successful nan 4th fourth of 2022 and we scheme to commence our afloat standard commercialized motorboat successful nan 2nd 4th of this year. We person besides made an enrollment advancement and our NITE 1 feasibility study successful acute ischemic stroke. And we proceed enrolling and learning successful 2023.

All said, we are enormously optimistic astir nan early of Silk Road medical. We are pleased to initiate guidance of $176 cardinal to $184 cardinal successful full-year 2023 revenue, reflecting astir 25,000 TCAR procedures astatine nan midpoint of nan range. We are assured successful nan twelvemonth up and successful our prospects for continued semipermanent growth.

I will now move nan telephone complete to Lucas Buchanan, our Chief Financial Officer and Chief Operating Officer.

Lucas Buchanan

Thank you, Erica. Revenue for nan three-months ended December 31, 2022 was $40.1 million, a 42% summation from 28.3 cardinal successful nan aforesaid play of nan anterior year. Growth was driven chiefly by accrued TCAR adoption, arsenic evidenced by our 5th consecutive 4th of maturation and procedures per trained physician.

The number of TCAR procedures successful nan 4th was complete 5,500 a 43% summation from nan aforesaid play of nan anterior year. Gross separator for nan 4th fourth of 2022 was 73% compared to 74% successful nan 4th fourth of nan anterior year. The diminution was driven by higher manufacturing costs associated pinch labour and materials and maintaining 2 manufacturing facilities.

With our caller finance successful manufacturing capacity, we expect our gross margins to beryllium somewhat little than anterior periods successful nan short-term, but we expect improved margins complete clip pinch accrued volumes and continued value discipline.

Total operating expenses for nan 4th fourth of 2022 were $41.7 million, a 19% summation from 35.1 cardinal successful nan 4th fourth of 2021. R&D expenses for nan 4th fourth of 2022 were $9.2 million, compared to 7.5 cardinal successful nan 4th fourth of 2021. The summation successful R&D spending was driven chiefly by maturation successful unit on pinch continued investments successful caller and ongoing programs.

Sales, wide and administrative expenses for nan 4th fourth of 2022 were $32.5 million, compared to $27.6 cardinal successful nan 4th fourth of 2021.

Now much than ever, we are focused connected operational excellence arsenic we execute greater scale. Last year, we dramatically accrued our manufacturing capacity successful quality resources and pinch these expanded efforts successful place, we are progressively focused connected proviso chain, value and creation for manufacturing initiatives to mitigate consequence and negociate input costs.

We look guardant to leveraging nan years of activity and investment, we person put down commercialized manufacturing, R&D and backmost agency infrastructure and we expect operating expenses arsenic a percent of gross to alteration going forward.

Net nonaccomplishment for nan 4th fourth was $12.6 cardinal aliases a nonaccomplishment of $0.34 per share, arsenic compared to a nett nonaccomplishment of $14.7 million, aliases a nonaccomplishment of $0.42 per stock for nan aforesaid play of nan anterior year. We ended 2022 pinch $213.7 cardinal successful cash, rate equivalents and short-term investments.

Having bolstered our equilibrium expanse done a indebtedness refinancing successful nan 2nd quarter, which added astir $25 cardinal to our rate equilibrium while besides providing further entree to liquidity and an equity financing successful nan 4th fourth which contributed astir 109 cardinal successful nett proceeds. Together these raises supply important further elasticity successful support of our business and maturation initiatives.

Turning to our 2023 outlook and commercialized strategy, we ended 2022 pinch a commercialized beingness successful complete 1100 hospitals pinch almost 2500 trained physicians served by 70 progressive income territories.

We expect nan incremental expert training and territory maturation successful 2023 and beyond arsenic we respond to beardown TCAR request pinch nan intent to maximize our return connected finance arsenic portion of our semipermanent profitability goals.

With a captious wide of territories, trained physicians and infirmary accounts entering 2023 we are good positioned to thrust maturation successful procedures per trained expert while besides driving operating leverage.

As Erica mentioned, we expect full-year gross to beryllium successful nan scope of $176 cardinal to $184 cardinal reflecting gross maturation of 27% to 33% complete 2022 based connected astir 25,000 TCAR procedures astatine nan midpoint of nan range.

As always, our guidance accounts for respective variables, including ongoing macro uncertainty and besides assumes continued normalization successful nan infirmary operating environment.

The gradual layering effect of our caller modular surgical consequence explanation description is reflected successful our guidance scope and we besides expect our gross per process opportunity to use modestly from nan rollout of nan inflate balloon.

As a reminder, we will support our reporting model going guardant and arsenic specified we will not beryllium breaking retired contributions of TCAR procedures by diligent surgical consequence profile, nor merchandise level revenues.

At this point, I would for illustration to move nan telephone backmost to Erica for closing comments.

Erica Rogers

Thank you, Lucas. I would for illustration to reiterate that 2023 will beryllium a twelvemonth of maturation and leverage for Silk Road carried by our squad who has focused connected building and scaling our level for nan past respective years to put TCAR successful nan hands of much physicians, and use arsenic galore patients arsenic possible.

Collaboration, excellence and a committedness to doing nan champion we tin for our providers and their patients are nan values astatine nan halfway of Silk Road civilization and we cognize that nan adjacent shape of our Company’s maturation will beryllium driven by a culmination of these factors.

With our wide based of session of objective grounds established commercialized footprint and afloat marketplace access, we are successful galore ways arriving astatine nan adjacent era and nan Silk Road aesculapian story. We are excited to proceed our activity successful earnest.

We will now unfastened nan statement to questions. Operator.

Question-and-Answer Session


Thank you. [Operator Instructions] Next caller is Travis Steed of Bank of America Securities. Travis your statement is open.

Travis Steed

Hi everybody, acknowledgment for taking nan question. I guess, I will commencement pinch nan guidance and possibly nan start, really to deliberation astir nan quarterly progression Q1 versus nan Q4, you conscionable did. And past connected nan 2023 guide, first, if you tin specify nan humble use connected value is that debased azygous digits aliases mid azygous digits, we person had to deliberation astir nan pricing. And erstwhile you deliberation astir marketplace penetration and nan 2023 guidance, it looks for illustration you did astir 2.5 points of our 3 points of marketplace penetration past twelvemonth and sewage successful for astir nan akin level of marketplace penetration is 2023 contempt Senate risk, truthful conscionable benignant of reasoning astir it. That is nan billing for marketplace penetration aliases really we should deliberation astir nan upside to that?

Erica Rogers

Yes. Hi Travis, acknowledgment very overmuch for your mobility and bully to person you connected nan telephone here. So fto maine conscionable talk astir nan benignant of top-line puts and takes first of all. As we said successful our prepared remarks, nan guideline really reflects, what we see to beryllium ongoing normalization and of nan operating situation and hospitals stability, of course, pinch pockets present and there, I would opportunity of immoderate labour shortages.

But it besides represents nan accrued momentum successful our business. And to your point, nan afloat marketplace entree and modular surgical consequence approval. As we person talked astir before, we are not going to break retired those trends by consequence factor, but alternatively benignant of talk astir it collectively. But I do deliberation it is important to constituent retired that moreover successful Q4, it was still early days successful nan rollout of modular surgical consequence support and safe to opportunity that that momentum is building.

I will fto Lucas return immoderate of nan elaborate answers to your question.

Lucas Buchanan

Yes. Travis acknowledgment for nan question. In position of nan quarterly cadence. It is going to beryllium different twelvemonth wherever it is benignant of backmost half loaded, which is partially a usability of a cadence of our continued territory description .

And our extremity for territories was 70 to 75 past year, and we reported that we met that astatine nan debased extremity of nan range, truthful we are still building from 70 to 75 and beyond passim nan year, and truthful we will spot benignant of that measurement up. Q1, historically has been flattish to Q4, location is immoderate COVID sound successful that. So possibly it is flattish to modestly summation and past we build from there.

In position of nan pricing, implied pricing and benignant of gross per process from inflate. Obviously, we request immoderate much clip to stitchery information arsenic to what nan pricing will beryllium successful nan afloat market, what nan utilization, what nan units per procedure. So we will springiness immoderate colour connected that arsenic we spell forward.

If you do nan math, connected our implied guidance, we are talking astir a gross per process metric successful astir nan $7,200 to $7,300 range. And obviously, that will benignant of beryllium astatine nan little extremity astatine nan opening of nan year, and perchance astatine nan higher end. That is our champion estimate, arsenic we beryllium present today.

And past connected nan penetration question, you are right, you person done nan mathematics astir right, astatine nan midpoint and procedures per doc is nan extremity of nan statement and moving this procedure, up nan take curve pinch nan afloat explanation and nan objective grounds and nan captious wide we person is nan job.

It is simply a very delicate metric and truthful if we are somewhat amended aliases somewhat worse, nan output will beryllium arsenic such, but that is wherever we are focused is connected driving nan take curve successful 2023 it is really a twelvemonth of commercialized execution.

Travis Steed

Great, very helpful. And I sewage nan follow-up for Lucas, would it beryllium connected nan amended leverage you tin get this year. Just funny really you tin put immoderate numbers astir nan leverage spot get aliases marketplace penetration for breakeven? And past a follow-up for Erica would conscionable beryllium connected nan CMS NCD review. Anything that travel retired of that are funny what would hap if it is nan consciousness that nan reimbursement there?

Lucas Buchanan

Yes, truthful we surely expect gross to turn faster than operating expenses this year. We are successful 2023, will person nan full-year effect of rather a spot of hiring we did successful 2022. We will besides incrementally put successful salesforce description , arsenic I mentioned, but we do expect operating expenses arsenic a percent of gross to proceed to tick down.

We did not supply a circumstantial gross standard aliases timing of profitability again, we really want 2023 nan twelvemonth of commercialized execution to show america what we are tin of pinch nan afloat label, nan further merchandise of nan merchandise portfolio and nan wide captious mass.

And truthful arsenic we advancement passim nan twelvemonth connected gross growth, and spot that operating leverage, we tin commencement to deliberation astir that that way to profitability.

Erica Rogers

Yes, and Travis connected your NCD reconsideration question. We proceed to judge location are a scope of favorable outcomes for Silk Road and for TCAR. And mostly we invited this opportunity for a wholesome reappraisal of nan evidence.

As you heard successful nan prepared remarks were sitting present pinch greater than 25,000 patients worthy of data. In adjacent review, precocious effect facet journals and much information are generated connected a regular ground successful nan existent world grounds of nan TCAR surveillance project. So we are pleased pinch nan outcomes that person been posted truthful far. We cognize that nan training metric, truthful let’s pinch little restrictive diligent criteria, each of those things are successful our favor.

In position of wherever we are, from a process constituent of view, nan first remark play down us. The nationalist comments are public, truthful you tin spot them. And we did of course, station a nationalist comment. July is nan first draught determination memo that will travel from CMS and we will hold to spot what happens and support our heads down and do nan bully activity we are doing successful nan meantime.

Travis Steed

Okay, great. Thanks for taking nan questions.


Our adjacent mobility comes from Robbie Marcus of JP Morgan. Robbie your statement is open.

Robbie Marcus

Great, congrats connected a bully quarter. Maybe nan follow-up aft Travis asked each nan questions. If I return Lucas astatine 25,000 procedures, it gives america gross per process astir $7,200 for nan year. How do we deliberation astir nan cadence of that done nan twelvemonth arsenic you adhd successful nan balloon, is it a much 2nd half weighted gross per process aliases akin to really you are building retired nan territories and I admit nan first 4th color. But is location thing abnormal astir nan 2Q to 3Q, 4Q ramp we should beryllium reasoning about?

Lucas Buchanan

Yes. First of all, I would construe nan astir 25,000 is connected nan nether thing over. And again, I deliberation nan mean is astir apt going to beryllium successful that 70 to 50 range, location has ever been quarter-to-quarter variability. But yes, it would apt standard from nan 7,200 scope up towards nan 7300 range.

Again, location is immoderate uncertainty connected precisely really overmuch utilization and units per process arsenic we get into nan afloat marketplace merchandise successful Q2 and beyond and a afloat marketplace merchandise still requires nan administrative churn of that committees and pricing contracts and those things. So we will advancement passim nan twelvemonth successful position of some nan territory description , nan procedures per-physician and nan connected formation publication connected nan margin.

Robbie Marcus

Got it. And arsenic you contemplate expanding extracurricular nan U.S. versus nan rate you now person connected nan equilibrium sheet. How are you considering M&A astatine this point, is location thing other you tin adhd into nan container of nan income reps that you deliberation mightiness beryllium worthwhile and accretive to nan business aliases is nan usage of rate solely connected TCAR successful nan U.S. and extracurricular nan U.S.? Thanks.

Erica Rogers

Yes. I admit nan mobility Robbie. Look, you cognize nan measurement to deliberation astir this business pinch 12% penetration closing retired 2022 successful nan United States is location is truthful overmuch room to tally here. And arsenic I said successful my prepared remarks, our champion finance for maturation is correct present successful nan United States successful U.S. TCAR description .

If you look astatine nan full marketplace opportunity of conscionable nan treated patients alone, we are conscionable getting started. So I deliberation it is safe to opportunity nan attraction is connected expanding nan take of TCAR and driving nan leverage we person correct present astatine location successful nan United States.

Robbie Marcus

Great. Thanks a lot.


And our adjacent mobility comes from Adam Maeder of Piper Sandler.

Adam Maeder

Hi, Erica. Hi, Lucas. Thank you for taking nan questions and congrats connected nan advancement successful 2022. I did want to commencement pinch 1 connected Q4 and conscionable excavation successful a small spot much there. I’m funny if you are capable to benignant of talk astir nan trends, month-by-month, October done December, you know, surely coagulated capacity and bully to spot nan business up 7% sequentially. But nan 4th grounds maturation was a small spot lighter than past quarter. So conscionable wanted to understand, immoderate considerations location and it frankly, could conscionable beryllium a quality successful trading days aliases seasonality from holiday, but thing you’d telephone out, and past I person a follow-up aliases two. Thanks.

Erica Rogers

Yes, hi, bully to perceive from you. Let maine conscionable springiness you immoderate high-level views. Coming retired of Q3, we talked astir nan comparatively much normal healthcare operating environment. We did be aware around, nan cold, flu COVID play perchance having an effect connected labour shortages successful Q4. But I deliberation it is safe to opportunity that we proceed to spot comparative normalization and nan operating environment.

And I will fto Lucas, talk about, you know, benignant of specifically your points connected trading days, etcetera.

Lucas Buchanan

Yes, and I conjecture nan short reply is thing circumstantial to telephone out, we are not really providing period to period commentary. It was a beardown 4th pinch nan 70 territories going retired to work, we had nan normal seasonality that we ever scheme for. And we are excited astir nan momentum successful betwixt 2023.

Adam Maeder

Okay, acknowledgment for nan incremental caller location and past for nan follow-up, wanted to inquire astir gross separator Lucas. A small spot of choppiness successful 2022 I deliberation because of nan 2nd manufacturing broadside and getting that up and running. How do we deliberation astir 2023? I deliberation I heard successful nan prepared remarks whitethorn beryllium immoderate near-term challenges. But you know, really do we deliberation astir progression of gross separator this year? Thank you.

Lucas Buchanan

Yes, I deliberation you should deliberation astir it likewise to benignant of nan top-line commentary, which is improvements much backmost half loaded. And I deliberation overall, we will beryllium astir akin successful gross separator percent arsenic 2022 for different reasons, we are carrying benignant of higher labour and materials costs that person been capitalized successful nan inventory and we are evidently carrying nan overhead of 2 manufacturing accommodation versus one.

And truthful arsenic we arsenic we support price, subject and thrust accrued portion measurement overtime, we will spot immoderate betterment perchance successful nan backmost half of nan twelvemonth and beyond and a small spot lighter successful nan successful nan beforehand half of nan year.

Adam Maeder

That is very helpful. Thank you.


Thank you. The adjacent mobility comes from Joanne Wuensch of Citi. Joanne your statement is open.

Joanne Wuensch

Good evening and convey you for taking nan question. I admit nan sequential commentary. I conscionable want to make judge that nan first 4th gets group up. I mean, really are you reasoning astir nan sequential 4th successful position of gross delivery, and I will inquire a follow-up question. If I did my mathematics correctly, you ended 2022 pinch astir 300 physicians trained. Are you successful a position to found a extremity for 2023?

Erica Rogers

Well, why don’t we return those successful reverse order, Joanne and acknowledgment truthful overmuch for joining america and for your question. So, successful nan twelvemonth of 2022, we achieved astir greater than 400 physicians trained, which was successful excess of really we had guided successful nan first portion of nan year, ending nan twelvemonth pinch astir 2,500 physicians trained, which is simply a awesome setup for 2023.

As we person talked astir before, training physicians is benignant of an finance successful our future. And you astir apt noticed, Joanne, that we did not guideline to a circumstantial number of trained physicians for this twelvemonth and 2023 and we astir apt won’t spell connected forward.

And that is because it is, it is benignant of de minimis compared to nan number of physicians that are already trained and nan existent maturation driver being moving these train physicians up nan take curve.

So nan champion measurement to deliberation astir it is benignant of mid to high-single-digit percent maturation and train physicians each twelvemonth from present connected forward. And that would include, of course, fellows, and younger physicians coming successful replacing nan aged retiree.

Lucas Buchanan

And, Joanne, your mobility connected sequential maturation was Q1 of this twelvemonth versus Q4 of past year, is that correct?

Joanne Wuensch


Lucas Buchanan

Yes. So I will reiterate immoderate of nan prepared comments and if location is simply a travel up, fto maine know. But again, nan humanities inclination has been astir flat, but nan humanities inclination includes immoderate COVID spikes successful various clip periods.

We ended nan twelvemonth pinch 70 territories and started nan twelvemonth pinch 70. And again, person a extremity to expand. And truthful I deliberation a batch of sequential maturation is nan correct measurement to deliberation astir Q1. And past arsenic we arsenic we get nan twelvemonth progressing and proceed commercialized description and proceed each of our initiatives and proceed nan on-slate rollout.

We will person immoderate sequential measurement ups from location pinch nan normal seasonality adjustments that we make. But astatine nan extremity of nan day, it is really procedures per doc and what are nan inputs astir driving, driving expert utilization and obviously, having nan folks retired successful nan field, spell do to their point much and much pinch much touch points is nan goal.

Joanne Wuensch

Sounds good. Thanks you for nan incremental answer.


Thank you. Our adjacent mobility comes from [John McKolly] (Ph) of Stifel. John you are open.

Unidentified Analyst

Hi Lucas, hullo Erica acknowledgment for taking my questions today. I conjecture to commencement off, taking a look astatine operating leverage for 2023. Maybe putting a finer constituent connected it. In 2022. You grew apical statement astir 37% and OpEx is astir 2024 for illustration a 13% delta. What do you spot successful 2023, do you spot that GAAP perchance widening, arsenic you benignant of scope much standard pinch nan Salesforce aliases do you spot OpEx benignant of continuing to turn successful that mid-20s percent range?

Lucas Buchanan

Yes. Short reply is mid-20s growth. And we don’t person circumstantial OpEx guidance, but nan things to deliberation about, again, nan biggest statement point successful nan institution is group costs and compensation costs crossed each functions and we did we did a adjacent magnitude of hiring successful 2022. So we will get nan full-year effect of salaries and bonuses and banal comp and things for illustration that.

The 2nd is nan continued description of nan number of income territories and past nan quality resources to thrust those territories. I deliberation from a G&A position and R&D perspective, arsenic I person said prior, those are really astatine dependable state, location is ever 4th to 4th variability. But I deliberation that each pencils retired to astir mid 20s growth, including non rate banal compensation expenses, wherever they are ever things, things going connected that statement point specifically.

Unidentified Analyst

Great, that is helpful. And past conscionable 1 much for me, benignant of from a bigger image perspective, you are talking astir benignant of reaching a captious wide of doc’s trained of objective data. I mean, what different factors, what other do you request successful spot do you deliberation Lucas aliases Erica, to accelerate CAGR maturation to nan 20%, 30%, 40%, 80% penetration conscionable benignant of looking for your large image thoughts there. Thanks for taking my questions.

Erica Rogers

Yes, absolutely. And you are right, John, admit that nan setup for occurrence is really location pinch trained physicians, unfastened territories, unfastened infirmary accounts and entree to nan afloat market. So I deliberation that nan short reply to your mobility is we are increasing and we are increasing meaningfully successful procedures per expert and overall.

And nan business of treating nan encephalon is 1 wherever clip and acquisition matter. And we person said this earlier that it takes an individual expert a twelvemonth to twelvemonth and a half conscionable to get comfortable pinch switching much and much patients to TCAR versus carotid endarterectomy.

And we cognize from our ain experience, that expanding nan touch-points, nan number of times nan quota caring professionals are successful beforehand of their physicians, that that helps to thrust adoption, which is 1 of our cardinal areas of attraction for this twelvemonth and beyond.

And I besides said successful my prepared remarks that much and much returning our attraction to patients. And we cognize that patients are doing much activity than ever, connected informing themselves astir curen decisions. And this is existent of immoderate illness state, not conscionable present and carotid artery disease.

And truthful we person really up leveled our engagement successful this area, some successful position of providing patients pinch nan acquisition worldly that they need, but besides really assessing really patients deliberation astir TCAR and peculiarly patients who person had some TCAR and carotid endarterectomy and taking immoderate results of immoderate early activity that we person done location and capitalizing connected patients for illustration TCAR. And that is conscionable 1 illustration of galore connected our attraction to person patients asking for TCAR much and more.


Thank you. At this time, I would now for illustration to move nan telephone backmost to Erica Rogers for closing remarks.

Erica Rogers

Thank you each for joining us.


Thank you for your information successful today’s conference. This does reason nan programme you whitethorn now disconnect.

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