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Date
Tuesday, July 29, 2025 at 8:30 p.m. ET
Call participants
Chairman and Chief Executive Officer — Adam Elsesser
Chief Financial Officer — Maggie Yuen
Executive Vice President of Strategy — Jason Mills
Head of Investor Relations — Cecilia Furlong
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Takeaways
Total revenue— $339.5 million in GAAP revenue for Q2 2025, representing 13.4% reported and 12.7% constant currency year-over-year growth.
US thrombectomy revenue— $188.5 million in US thrombectomy revenue for Q2 2025, up 22.6% year-over-year, with "42% year-over-year growth in our US VTE franchise," driven by adoption of Flash 2.0 and BOLT 12.
Gross margin— 66% GAAP gross margin in Q2 2025, compared to 54.4% in Q2 2024, which included a $33.4 million one-time inventory write-off; gross margin slightly decreased sequentially due to the Excel launch and higher international mix.
Geographic revenue mix— 76.8% US and 23.2% international revenue mix in Q2 2025; US growth was 19.5%, while international declined 3.2% reported and 5.8% constant currency due to continued China headwinds partially offset by other regions.
Global thrombectomy revenue— $130.3 million in global thrombectomy revenue for Q2 2025, up 13.1% reported and 12.6% constant currency compared to the same period last year, with US growth at 22.6% and international thrombectomy revenue up 16.2% on a reported basis (though negatively impacted by China declines).
Embolization and access revenue— $109.2 million in revenue from the embolization and access business for Q2 2025 (GAAP), up 13.9% reported and 12.8% constant currency compared to the same period last year; US embolization sales increased, aided by the new Excel product launch.
Operating expenses (non-GAAP)— $183.2 million, or 54% of revenue (non-GAAP) for Q2 2025, versus $164.5 million, or 54.9%, in Q2 2024; research and development expense (non-GAAP) decreased, reflecting a $5.2 million savings from the immersive business wind-down offset by ongoing product development investment.
SG&A expense— $160 million, or 47.2% of revenue, up from $139.6 million, or 46.6% of revenue, in Q2 2024, as a result of accelerated hiring of over 50 embolization sales reps and 40 vascular clinical specialists.
Operating income (non-GAAP)— $40.8 million, or 12% of revenue (non-GAAP) for Q2 2025, compared to a non-GAAP operating loss of $1.6 million in Q2 2024 (which included a $33.4 million inventory write-off); operating profit increased by $9.1 million on a non-GAAP basis, excluding the one-time write-off.
Adjusted EBITDA— $61.4 million, or 18.1% of revenue (adjusted EBITDA, non-GAAP) for Q2 2025, compared to $13 million, or 4.3%, in Q2 2024.
Cash, cash equivalents, and marketable securities— $424.6 million in cash, cash equivalents, and marketable securities at Q2 2025 quarter end, with no debt and a sequential increase of $45.7 million due to strong operating profitability.
Full-year revenue guidance— Raised full-year 2025 total revenue guidance to $1.355 billion–$1.370 billion (13%-15% year-over-year growth); US thrombectomy growth guidance maintained at 20%-21% year-over-year.
Gross margin outlook— On track for over 70% gross margin by 2026, with management stating that the Ruby Excel coil is "accretive to our margin" and "we are on track for our 70 plus percent at 2026" (referring to gross margin, as discussed on the Q2 2025 earnings call).
Salesforce restructuring— Separate peripheral embolization sales force created and trained, enabling dedicated focus for the thrombectomy team and supporting the launch of Ruby XL, with expected "ramping benefit from our investment in our commercial team through the back half of the year and beyond."
STORM PE clinical trial— Enrollment completed ahead of schedule; the study is the first randomized controlled trial comparing anticoagulation plus mechanical thrombectomy versus anticoagulation alone for intermediate high-risk PE, with results to be presented at a major medical conference in fall 2025.
Thunderbolt product— Regulatory review in progress with the FDA; management expressed ongoing high confidence, stating, "I do not know how to say it anymore than I've said it over and over. It is an amazing product."
China sales impact— International revenue decline was driven by reduced China revenue, with a "small order" placed after easing of tariffs; impact not considered material, and outlook is for China headwinds to ease in coming periods.
Summary
Penumbra(PEN -1.08%) delivered double-digit GAAP revenue growth of 13.4% year-over-year for Q2 2025, driven by US thrombectomy performance, embolization and access adoption, and disciplined gross margin execution. Management reported a fully trained and newly deployed separate peripheral embolization sales force, anticipated to accelerate results in the second half of 2025. The company confirmed enrollment completion of the STORM PE trial, emphasizing its significance as the first global randomized study comparing thrombectomy plus anticoagulation to anticoagulation alone in PE. While international GAAP revenue declined 3.2% due to China headwinds, management cited imminent easing and early signs of recovery in other regions. Full-year 2025 revenue guidance was raised, with GAAP gross margin and non-GAAP operating margin targets reaffirmed for the year, and management highlighted confidence in achieving a GAAP gross margin profile of over 70% in 2026.
Management underscored that margins are expected to benefit from the launch of Ruby Excel, which is considered margin-accretive despite recent inventory buildup costs, as discussed on the Q2 2025 earnings call.
Adam Elsesser repeatedly emphasized excitement and confidence in the Thunderbolt device, refuting any concerns about waning product enthusiasm during the ongoing FDA review process.
The US VTE franchise led segment growth, with management noting "over 50%" share in DVT and increasing penetration in PE, both supported by strong product adoption.
Research and development spend decreased due to the immersive business wind-down, while non-GAAP SG&A increased with targeted commercial team hires to fuel future growth initiatives.
Management described the international business as moving past prior restructuring, with new product launches driving momentum.
Industry glossary
CAVT: Computer-assisted vacuum thrombectomy — a proprietary Penumbra technology platform used for removing blood clots.
VTE: Venous thromboembolism — a condition involving blood clots in the venous system, including DVT (deep vein thrombosis) and PE (pulmonary embolism).
PE: Pulmonary embolism — a blockage in one of the pulmonary arteries in the lungs, commonly caused by blood clots.
DVT: Deep vein thrombosis — formation of a blood clot in a deep vein, usually in the legs.
STORM PE: A multicenter randomized controlled trial evaluating CAVT plus anticoagulation versus anticoagulation alone in acute intermediate high-risk PE.
AMBo: Penumbra’s dedicated sales team for embolization therapies.
MMA: Middle meningeal artery — a cerebral blood vessel often treated with embolization coils for certain conditions.
CORAL: Penumbra's embolization product portfolio, referenced as being provided to physicians by the new AMBo team.
Full Conference Call Transcript
Cecilia Furlong: Thank you, operator, and thank you all for joining us on today's call to discuss Penumbra's earnings release for 2025. A copy of the press release and financial tables, which includes a GAAP to non-GAAP reconciliation, can be viewed under the Investors tab on our company website at www.penumbrainc.com. During the course of this conference call, the company will make forward-looking statements pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements regarding our financial performance, commercialization, clinical trials, regulatory status, quality, compliance, and business trends.
Actual results could differ materially from those stated or implied by our forward-looking statements due to certain risks and uncertainties, including those referenced in our 10-Ks for the year ended 12/31/2024, filed with the SEC. As a result, we caution you against placing undue reliance on these forward-looking statements, and we encourage you to review our periodic filings with the SEC, including the 10-K previously mentioned, for a more complete discussion of these factors and other risks that may affect our future results or the market price of our stock. Penumbra disclaims any duty to update or revise our forward-looking statements as a result of new information, future events, developments, or otherwise.
On this call, financial results for revenue and gross margin are presented on a GAAP basis, while operating expenses, operating income, and adjusted EBITDA are presented on a non-GAAP basis. The corresponding GAAP measures and a reconciliation of GAAP to non-GAAP financial measures are provided in our posted press release. Non-GAAP operating expenses and operating income exclude amortization of acquired intangible assets of $2.4 million and impairment of our Immersive Health Care business of $76.9 million in 2024, and adjusted EBITDA excludes impairment expenses, stock compensation expense, depreciation and amortization, provision for income taxes, and interest income expenses.
Adam Elsesser, Penumbra's chairman and CEO, will provide a business update, Maggie Yuen, our Chief Financial Officer, will then discuss our financial results for 2025, and Jason Mills, our Executive Vice President of Strategy, will discuss our updated 2025 guidance. With that, I would like to turn over the call to Adam Elsesser.
Adam Elsesser: Thank you, Cecilia. Good afternoon. Thank you for joining Penumbra's second quarter 2025 conference call. In the second quarter, we generated total revenue of $339.5 million, representing underlying year-over-year growth of 13.4% on a reported basis and 12.7% on a constant currency basis. Our second quarter performance reflected extraordinary ongoing execution by our commercial team against our strategy. Together with our focus on continuous innovation, clinical and health economic data generation, and the work physicians are doing to further expand the total number of patients treated globally with our novel technologies. Our US thrombectomy business led overall growth in the quarter, with results reflecting strong continued adoption and ramping utilization of our CAVT portfolio.
While our US embolization and access business, as well as our international business, delivered solid growth ahead of expectations. Second quarter US thrombectomy revenue increased 22.6% year over year to $188.5 million, led by 42% year-over-year growth in our US VTE franchise. As the clinical benefits of Flash 2.0 and BOLT 12 continue to support and drive further market penetration and competitive conversions. Below the top line, gross margin of 66% was in line with our prior announced expectation as we executed on our planned accelerated Ruby Excel inventory build.
We began shipments of Excel at the end of the second quarter and entered the third quarter well-positioned from an inventory standpoint to meet the strong interest in Excel we've seen in the field to date. We remain on track and are well-positioned to achieve a gross margin profile of over 70% by 2026 and expect operating margin expansion to outpace gross margin expansion for the foreseeable future as we prioritize delivering profitable growth and an expanding profitability profile. Turning to our US peripheral business.
Our second quarter thrombectomy performance reflected the competitive strength and clinical benefits of our comprehensive current CAVT portfolio, spanning Flash 2.0, BOLT 6X, BOLT 7, and BOLT 12, alongside purposeful and focused execution by our commercial team. We treated more VTE patients in the quarter than in any prior period, supported by our team's relentless focus and prioritization on improving patient outcomes, driving conversions from anticoagulation, lytics, and other mechanical thrombectomy platforms to CAVT in both PE and DVT. In arterial, the clinical benefits of our modulated aspiration technology in BOLT 7 and BOLT 6X continue to support and drive physician conversions from open surgery or the use of lytics to CAVT.
Based on our consistent success and our clear view of the opportunity ahead in peripheral thrombectomy, we strategically invested in the build-out of a separate peripheral embolization sales force to provide heightened focus in thrombectomy and embolization. We have added over 50 embolization sales reps and over 40 vascular clinical specialists. With these new hires in place, we will be able to have a team solely focused on our thrombectomy business, as well as a separate team focused on launching Ruby XL and driving long-term growth in our embolization business. Adding to the information we provided on our last earnings call, Ruby Excel is a larger, softer, and longer coil than other commercially available coils.
And allows us to now participate quite effectively in about 20% of the current market that we have not been able to in the past. With the early performance of Ruby Excel, we expect to see ramping benefit from our investment in our commercial team through the back half of the year and beyond. With our thrombectomy team well-positioned to exclusively focus on continuing to address the significant unmet need in the treatment of clot burden throughout the body, our new AMBo team is able to focus on providing our comprehensive CORAL portfolio to physicians and hospitals.
As our team drives adoption of our technology on a day-to-day and account-by-account basis, we are simultaneously focused on positioning CAVT for long-term growth while enhancing our competitive position. Advancing the field through technology innovation and high-quality clinical data generation is our priority. During the quarter, we completed enrollment in STORM PE, a prospective multicenter randomized controlled trial evaluating CAVT plus anticoagulation versus anticoagulation alone for the treatment of acute intermediate high-risk PE. We are committed to running trials which hold the potential to fundamentally shift patient treatment, and STORM PE has the potential to provide level one evidence to help inform PE treatment and impact standard of care.
Enrollment in STORM PE completed ahead of schedule, and we look forward to presenting the results from the trial at a major medical conference this fall. On the arterial side, we recently announced the launch of our STRIDE 2 study. Our initial STRIDE study, which incorporated primarily older generation technology, demonstrated compelling results, including a 98.2% thirty-day limb salvage rate. With STRIDE 2, we intend to both expand the patient sample size and broaden the geographic enrollment base in comparison to STRIDE, with STRIDE 2 focused on demonstrating the benefits of our latest CAVT technology.
Looking forward, we will continue to invest in high-quality clinical studies in tandem with our market access initiatives to highlight the significant benefits and value proposition of our differentiated current and forthcoming products. Shifting to our neurovascular business. Excuse me. Our US stroke thrombectomy franchise delivered another solid performance, growing ahead of the underlying stroke market. In its first full quarter on the market, Red 72 Silver Label, with its enhanced trackability, continued to generate strong physician interest and saw ramping adoption and utilization. Regarding Thunderbolt, we are currently in an active process with the FDA and will provide additional updates as soon as possible. We remain very excited to introduce Thunderbolt to the neurovascular field.
At SNIS earlier this month, there was a great deal of discussion about distal occlusions in stroke. We heard many physicians confirm that our Red 43 aspiration catheter is the preferred device to treat patients with distal occlusions. Finally, there was a lot of discussion among physicians about embolizing the middle meningeal artery or MMA as it is commonly known. And the unique properties of our Swift coil that allows for the safest treatment modality. It is estimated that there are more patients that could be treated in this category than traditional cerebral aneurysms. We are focused on investing in further innovation across our diversified neuro portfolio, spanning aspiration, access, and embolization.
In summary, our second quarter results reflect solid execution by our team, as we continue to deliver long-term growth in multiple underpenetrated markets. We are committed to continuing to transform patient care across these markets and are excited to introduce new innovative products in the months and years ahead. I'll now turn the call over to Maggie to cover our financial results for 2025.
Maggie Yuen: Thank you, Adam. Good afternoon, everyone. Today, I will discuss the financial results for 2025. Financial results on this call for revenue and gross margin are on a GAAP basis, while operating expenses, operating income, and adjusted EBITDA are on a non-GAAP basis. The corresponding GAAP measures and our reconciliation of GAAP to non-GAAP financial measures are provided in our posted press release. For the second quarter ended 06/30/2025, our total revenues were $339.5 million, an increase of 13.4% reported and 12.7% in constant currency compared to 2024. Our geographic mix of sales for 2025 was 76.8% US and 23.2% international.
Our US region reported growth of 19.5%, driven by 22.6% growth in our thrombectomy franchise compared to the same period last year. As we anticipated, our international regions decreased 3.2% reported and 5.8% in constant currency, primarily due to a decrease in China revenue compared to the same period last year, which was partially offset by an increase in all other international regions. As we look ahead for 2025, we expect headwinds in China to ease, resulting in a return to growth across all of our international regions. The sequential growth in our total revenue of 4.7% was driven by both an increase in global thrombectomy and embolization and access revenue across all regions compared to 2025.
Moving to revenue by products. Revenue from our global thrombectomy business grew to $130.3 million in 2025, an increase of 13.1% reported and 12.6% in constant currency compared to the same period last year, which was primarily driven by growth in our US thrombectomy business of 22%. Our international thrombectomy business increased by 16.2%, in line with expectations, primarily due to a decline in China revenue. Excluding the impact on the China region, our international thrombectomy revenue grew by 14.4% when compared to the same period last year.
Revenue from our embolization and access business was $109.2 million in 2025, an increase of 13.9% reported and 12.8% in constant currency, primarily driven by an increase in US embolization sales, underscoring the launch of our new Excel product. Gross margin for 2025 is 66% compared to 54.4% for 2024, which includes a one-time $33.4 million immersive health care inventory write-off. Excluding this one-time write-off, the gross margin slightly increased year over year. As expected, our gross margin slightly decreased sequentially due to investment in the launch of our Excel product and the high international mix of growth across all regions. As we move to 2025, we expect to see sequential margin expansion from favorable product mix and productivity improvements.
In addition, we are on track to achieve our full-year gross margin targets. However, as our separate thrombectomy and AMBo teams start ramping, we might see some month-to-month variability in product mix. Importantly, we remain well-positioned to deliver our long-term growth margin profile of 70% by 2026. And now on to our non-GAAP operating expenses, non-GAAP operating income and margin, and adjusted EBITDA. Total operating expense for the quarter was $183.2 million or 54% of revenue compared to $164.5 million or 54.9% of revenue for the same quarter last year.
Our research and development expenses for Q2 2025 were $23.2 million or 6.8% of revenue compared to $24.9 million or 8.3% of revenue for Q2 2024, which reflects savings of $5.2 million due to our immersive business wind-down offset by continued investment in product development. SG&A expenses for Q2 2025 were $160 million or 47.2% of our revenue for Q2 2025 compared to $139.6 million or 46.6% of revenue for Q2 2024. To support the momentum in demand and ensure we are positioned to capitalize on long-term growth drivers, we made targeted hires in our commercial and market access teams.
Sequentially, our expense increased by $6.5 million, which, as Adam mentioned, was primarily due to a deliberate front-loaded investment in our embolization sales team and additional vascular clinical specialists. With a favorable hiring market to attract top-tier talent, we acted to bring in a high-impact commercial team, which we expect will contribute to our results in the quarters ahead. We recorded operating income of $40.8 million or 12% of revenue compared to an operating loss of $1.6 million for the same period last year, which includes a one-time $33.4 million healthcare inventory write-off. Excluding this one-time write-off, our operating profit increased by $9.1 million.
We posted adjusted EBITDA of $61.4 million or 18.1% of total revenue compared to $13 million or 4.3% in the second quarter last year. Turning to cash flow and balance sheet. We ended 2025 with cash, cash equivalents, and marketable securities balance of $424.6 million and no debt, which is an increase of $45.7 million sequentially driven by strong operating profitability. We expect positive operating cash flow trends to continue in 2025 and beyond. And now I'd like to turn the call over to Jason to discuss our updated 2025 guidance.
Jason Mills: Thank you, Maggie, and good afternoon, everyone. Due to outperformance in the second quarter, we are increasing our guidance for total revenue to a range of $1.355 billion to $1.370 billion, which represents 13% to 15% year-over-year growth. We maintain our guidance for US thrombectomy growth of 20% to 21% compared to 2024 levels. We also maintain our guidance for both gross margin and operating margin for full-year 2025. This concludes our prepared remarks. Operator, we can now open the call to questions.
Operator: Thank you. And at this time, I would like to remind everyone, in order to ask a question, press star followed by the number one on your telephone keypad. And our first question comes from the line of Larry Biegelsen with Wells Fargo. Your line is open.
Larry Biegelsen: Good afternoon. Thanks for taking the question and congrats on a nice quarter here. Adam, I wanted to start with STORM PE and then ask a Thunderbolt question. So it's good that we're gonna see the STORM PE data this fall. Adam, it's a relatively small study, and we've seen, you know, many PE trials with RVLD ratio as the primary endpoint. So why is this study important, and what could it have if positive? And I had one follow-up.
Adam Elsesser: Yeah. No. It's a great question. As you know, Larry, it's the first randomized study completed that we're aware of in the world comparing anticoagulation and mechanical thrombectomy to anticoagulation alone. So we've seen lots of single-arm studies and other things. It's the first randomized study that has that comparison, which is the question that everyone wants answered. So for that reason alone, it's significant. The size of the study is a testament to the confidence in the product. Obviously, the larger the study, the more room you know, you have to have, you know, a difference. You have 100 patients. It's a lot smaller number of patients to show that difference.
So it actually is a testament to, I think, the confidence in the study. That being said, I think that you're aware we put together an internationally very renowned group of physicians to create on the steering committee of this trial, they were the ones who came up with the endpoints and the size of the study and the powering of it all. And really and these are just not interventionalists. These are non-interventionalists. In the field of treating PE. So I think it's again, we'll wait to see the results, but I think it could have a significant impact. And the design of the study is a testament to the work of some of the world's experts.
Larry Biegelsen: That's helpful. And then on Adam, any update on how we think about the FDA review time? I think in the past, if I'm not mistaken, you've pointed to precedents and, you know, had about a six-month review time. And lastly, some investors, Adam, I think, have construed some of your recent comments that your enthusiasm for Thunder has changed. Could you address those items, please? Thanks.
Adam Elsesser: Sure. Yeah. I don't remember saying six months for a clinical study. The, you know, product review times vary depending on the company. That being said, I can tell you the following. You know, we worked with the FDA for many, many years, the neuro division. I can tell you that they are thorough. Which is something that I'm extremely supportive of. These are obviously products going up in people's brains, and I'm very supportive of that process. The process is what we expected, with the FDA, and, to be honest, I've heard the rumors that I'm somehow not excited. I do not know how to say it anymore than I've said it over and over.
It is an amazing product, and I think it will have a huge, huge positive impact for many, many people for many, many years to come.
Larry Biegelsen: Alright. Thanks so much. Hey, thanks for taking the question. I guess the first question, I'll ask about Salesforce split. You know, why now is the right time? And you're thinking about the kind of any near-term disruption from that and the kind of the margin question. I know there was a comment kind of made on the mix on margins.
Adam Elsesser: Yes. So the well, the margin the comment I made about margins in my talk was we had said on the last quarter that we were accelerating the build of Ruby Excel, so there'd be a one-time one-quarter impact to do that, which we saw a minor impact. That doesn't go beyond this quarter, and I think we reiterated, very clearly that we are on track for our 70 plus percent at 2026. That being said, it is worth noting that the Ruby Excel is their margin, given the nature of that coil and the price point, is actually accretive to our margin. And so that's a positive for us. Why now? For the split here?
It is essential given the success that we're having in the thrombectomy side on that business. And our view of where that's, you know, continued growth will come. It's a pretty extraordinary opportunity. That we really need to have people be able to focus. They can't you know, they're selling right now on the thrombectomy side alone into the arterial DVT, PE, coronary, and then to add a whole bunch of different types of embolization procedures was a lot for our reps to do, and to do it well across all of their customers. So this just makes sense to do it by focus.
I think we have been lucky to be able to attract literally some of the best talent, there is in the field. And I think it will prove to be great for our thrombectomy business, because that focus and to be honest, it will be allow our peripheral coil business, our embolization business to continue to be successful and probably accelerate growth given the launch of the product. And the focus that team has. So it makes sense all around.
Larry Biegelsen: Thank you. And then kind of the second question is on The US thrombectomy business. The 20% to 21% guide. You kind of did 24% the first half, kind of implies 18% in the second half. I know the stroke market slowed a bit. I know that's kind of the main reason there, if there's any kind of thing else you'd call out for the second half of The US thrombectomy business.
Adam Elsesser: Yeah. No. I think it's fairly obvious, you know, that we're pretty excited about our thrombectomy business going forward. Obviously, we raised our overall guide, you know, the quarter before, we raised our US thrombectomy guide. And I think we're just to be honest, trying not to get ahead of ourselves, in spite of our enthusiasm right now.
Larry Biegelsen: Alright. Great. Thank you. Congrats on a good quarter.
Adam Elsesser: Thank you.
Operator: And our next question comes from the line of Robbie Marcus with JPMorgan. Your line is open.
Robbie Marcus: Great. Thanks for taking the questions. Wanted to ask on margins.
Maggie Yuen: And if there's any way you could quantify the impact of the additional Salesforce buildup here you know, gross and operating margins came in below the street. Just trying to real figure out if it's that or if it's maybe tied to the outside US AMBO and other outperformance. Maybe there was some stocking there or something like that. Thanks.
Adam Elsesser: Sure. Maggie?
Maggie Yuen: No. Thanks. I can take on the margin impact first. In terms of our investment in our commercial team, it has no impact on our gross margin. I think, the comment that I make about the mix as a result of the commercial team investment is because, like, Adam mentioned, of our thrombectomy and the new Excel product are accretive, and they both lead to supporting our 70% margin profile. So but in terms of the timing of the margin mix, it just could vary from month to month quarter to quarter. But nevertheless, we still continue to see expansion in Q3 and in Q4 at the same time.
In terms of operating margin, I think, in our commercial team has been in our strategic investment for the year. It's just for the right timing and right opportunity. We accelerate some of the investment in Q2. But at the same time, overall, we are still maintaining our full-year guidance, so no material impact on the out quarters. Thank you.
Robbie Marcus: Great. Maybe a quick follow-up. Adam, you know, now that we don't really have a lot of detailed reporting now that your competitor has been acquired. As I'm thinking about US thrombectomy, I was wondering if you could just give us a quick state of the union of what you think sort of the end market growth rates are in stroke in the different areas in Peripheral. As I'm looking at US thrombectomy, reiterating the guide implies, it deceleration in the back half of the year. I'm just trying to figure out what's your weighted average end market growth in US thrombectomy relative to the Penumbra growth rate? Implied? Thanks a lot.
Adam Elsesser: Yeah. It's a fair question. It's as you know, hard to get accurate, market information, particularly when we're the only ones sort of talking about our numbers. You know, you can't really triangulate them with other people's real numbers, so you're getting these sort of partial datasets and trying to triangulate it. So I don't want to over-rely on those kinds of sources because they've proven not always to be accurate as everyone knows. Let me I'll share sort of the best I can sort of how we're going. Obviously, our VTE growth is leading the way through quarter in a row of over 40%. Obviously, the market isn't growing at 40%.
It's growing, you know, somewhere around 20%, give or take, is our best guess. So again, we're continuing to take share there. The arterial business, again, it's less about a market growth there because you're really treating all those patients, but mostly with open surgery analytic. So it's moving those patients from one modality to us. That had another very strong quarter. You know, we grew similar to what we've done in the past couple of quarters. The market growth in neuro, you know, I won't you know, I'll be honest, was a little soft, but we continue to grow well above that number as we can tell because of the setup with Red 72 ascended, the silver label version.
And, frankly, it puts us in a really, really good position. I've always said that we want to try to move physicians to that product in anticipation of the Thunderbolt launch. And I think it's given us that opportunity to really do that. Having growing above the market shows that the share is shifting. And the setup for Thunderbolt is great. And then, obviously, our coronary business, it's a much more mature business. And it's obviously not growing at those same levels.
Robbie Marcus: Very helpful. Appreciate it, Adam.
Adam Elsesser: Yeah. Of course.
Operator: And our next question comes from the line of Richard Newitter with Truist. Your line is open.
Richard Newitter: Hi. Great. Thanks for taking the questions. Congrats on the quarter. I wanted to go back to the kind of some of the Salesforce initiatives you have going on here. Adam, you had you know, in late 2023, I believe, you know, you identified the need for an extended sales organization. Yep. With so many different call points kind of coming in. And that was kind of more feet on the street. And here, you're taking a little bit of a different approach, you know, splitting the sales organization. You gave the rationale and an answer to a prior question.
I'm just curious how do we think about the impact on the business and the time that will take to get the return on that investment or the payoff, you know, before one plus one equals two? You know? And if you can compare and contrast kind of you know, this initiative versus the prior one.
Adam Elsesser: Yeah. It's a fair question. The good news is we aren't starting the process of hiring those people. We've already hired them all. The vast majority of them have fully been trained and in the last, you know, month or so have been sort of operational, if you will, in the field. And so we already kind of are past that process of sort of, you know, going through that, And I have a lot of confidence that as we look at the back half, you know, those teams will be operating exactly how they should be focusing on what they should be focusing on. Obviously, we're still one team, you know, overall, and they're sharing managers.
So there's gonna be some capacity to help each other out and do all that, which I think is really important. For the long-term success. But their incentives are aligned to focus on the parts of their business that they're assigned to, and I think we're gonna be in really good shape. I think a lot of the heavy work is done and has been in play you know, moving in that position for the last number of months. So I think we're in pretty good shape. It's a great idea. I mean, the team came up with it. I'm thrilled. Their execution on it has been really extraordinary.
Know, you always have a little bit of stuff going on, but I think all of that is very minor and is behind us.
Richard Newitter: Got it. And then just maybe a follow-up. So I appreciate you don't want to get ahead of yourself. The first half is clearly coming in a little bit better than expected. You know, on US Venus and then also on embolization. And there's the implied deceleration that's in your guide. Maybe that reflects some conservatism. But assuming all trends were to hold, more or less, is there any one division that you anticipate a slowdown or you're seeing something in the underlying market? I'm just trying to get a sense for within our US arterial or US neurothrombectomy or even coronary? Like, is there any anticipated slowdown or trend that's beginning to emerge that you're seeing?
Adam Elsesser: No. I think I sort of laid out you know, the two areas that have you know, a little bit softer growth, if you will. Obviously, stroke as a market, you know, I think if you look at all the data that people, you know, can buy out there, it shows that it really didn't grow a lot in the last months or so. But we continue to take share. I think that you know, that is great for us. You know, I think that will continue. Particularly as, you know, the market digests sort of what the right size product is and how that all works. And sort of that setup and sort of getting ready for Thunderbolt continues.
So I think that puts us in an okay shape predicting the time of all that you know, give you know, gotta give us a little leeway to you know, we don't control that, and we need to sort of be a part of that. And, the coronary business is a great business. We treat a lot of patients, but it's a much more mature business, you know, with sort of analog technology, which is great in coronary, but that's obviously not growing at that level.
So there's nothing other than that, and us just being obviously you know, we have you know, we're we still have fresh memories of, you know, in having our enthusiasm get the better of us, and we're not gonna try not to do that.
Richard Newitter: Yep. No. I'm not criticizing. That's the right thing to do. Okay. Thank you. Thank you.
Operator: And our next question comes from the line of Bill Plovanic with Canaccord. Your line is open.
Bill Plovanic: Great. Thanks. Thanks for taking my questions. Just first off, you know, it looks like it was really the and the Embo Access that kind of drove some upside in the quarter. Kind of adverse, at least, our expectations, I think, consensus. But I'm just wondering if there's any sea change you saw there or are some of these markets coming back sooner than you expected? And then maybe even specifically on China, think there was some commentary there. I know you had zero in for this year. Is that how that's coming in? Or is that starting to come back on board? And then I have one follow-up.
Adam Elsesser: Yeah. Look. I think we have as you know, we had some headwinds internationally for a number of reasons over the last year or so. Obviously, the scale of the pullback on our China business has been a headwind for a couple of years. We got out of some markets, you know, because of gross margin issues. And so that was a headwind for a while. So we've been really working pretty diligently for a while to sort of make sure our international business is set up for success. Obviously, in certain markets, our CAVT products like Flash 2.0 and the Bolt products are in those markets now and starting to launch.
So we're starting to see the benefits of all that work, and that's really what you're seeing right now. And, you know, it's great to see it come together, but again, what ultimately will continue to drive it is, you know, the US thrombectomy business. But now a little bit with some of the embolization business because I think we've got a good run ahead with that Ruby XL product, which is I'll be honest with you, of the great compliments are coming from physicians who are using that and really seeing just extraordinary things that they can do for their patients. It's very gratifying. So I think we're set up.
Bill Plovanic: In China, contribution in the quarter, Maggie?
Adam Elsesser: Oh, I'm sorry. You did ask that question. I apologize. I should have I didn't write that question down. So, when there was a lifting of the or pausing of the tariffs or whatever we call it, China did ask for a small order. It was not particularly material, but we did fill it.
Bill Plovanic: Okay. Yeah. Thanks. And then on my follow-up, just you know, I understand and appreciate kind of the process with the FDA on Thunderbolt. I just you know, you've submitted your you know, you ran your trial. You've submitted your filing. You're going through the process. I think your commentary was nothing surprising. You know, it you know, at this point, you should be getting towards the end of that. Is there any more like, data or studies or anything else you need to provide, or is this just answering basic questions and labeling? We think about the process to get the product cleared from the FDA on the market?
Adam Elsesser: I 100% appreciate and respect the question. I think there's only you know, I'm only gonna get in trouble if I answer that because it's gonna be a nuanced thing that I'm it's gonna be misunderstood. And I don't want that to be done. Let me stick with what you know, I said, which is we're going through the process. It's what we expected, and we can't wait to launch this product.
Bill Plovanic: Alright. Great. Thanks, Adam. Thanks.
Adam Elsesser: Alright. Thank you.
Operator: And our next question comes from the line of Brandon Vasquez with William Blair. Your line is open.
Brandon Vasquez: Everyone. Thanks for taking the question and congrats on the quarter. Adam, coming out of SNIS, I think there was a little discussion about potentially being able to reinvigorate some of these efforts or kind of, like, refocus the neuro community onto getting these patients into the stroke centers and prioritizing thrombectomy. Appreciate we might be early in that, but as we're moving past COVID and this might become a little bit more of a focus now in the stroke markets, maybe the growth has been a little bit dampened. How do you think about what Penumbra can do? Do you think about what the industry is doing?
Is there a point where in the near future where we can start to reaccelerate the growth of the stroke market?
Adam Elsesser: Yeah, Brandon. I think it's a really important question and one that I actually think a lot about since we've been here for many, many years. Trying to make sure that happens. There is no question there are some you know, and frankly, a decent number of some just extraordinary centers, hospitals, physicians, leaders, who are doing that work in their communities to make sure that everyone that can be treated should be treated is getting treated. And that is the most heartening thing when we see that. Unfortunately, it's not at every town, at every community, at every hospital. And I don't know how fast the centers that aren't doing that, you know, will sort of get on board.
I can't predict that. But it is still happening, and it's exciting to see that. I think you know, like anything, you know, that has been sort of the big challenge with the neuro business, the stroke business, making sure that people get to the right place to be treated. That's obviously one of the reasons we're seeing such higher growth on the bachelor side because they don't have that issue. They go to a hospital and they can be treated in almost every place they go. But I'm optimistic.
I do think that Thunderbolt helps that because I do think it allows for a much faster, easier, you know, procedure, hopefully, that allows people to sort of, in effect, democratize it and feel like they can treat more of those patients. But let's wait and see. I don't want to get ahead of ourselves. We'll wait till that's approved, and we'll see what happens. But I'm optimistic.
Brandon Vasquez: Okay. And then maybe as a follow-up on the Envo side of the business. You know, now that you're building out a Salesforce, there's some new products like Ruby Excel and maybe Swiftpack and the MMA embolization. I'm kind of curious if you would categorize this as maybe a little bit of a turning point for Ambo. Is this in the sense of the can this be kind of a materially even better part of the business? Once this separate kind of Salesforce builds out? It seems like you're viewing a big opportunity there. Please rein me in if I'm getting ahead of my own skis here. But clearly, you're seeing something.
Is this something in a year from now gonna be looking back and saying this is why Penumbra invested so much into this segment. Thanks.
Adam Elsesser: Yes. That's what I hope.
Operator: And our next question comes from the line of Ryan Zimmerman with BTIG. Your line is open.
Ryan Zimmerman: Thank you. Can you hear me okay?
Adam Elsesser: Yes.
Ryan Zimmerman: Thank you. Alright. Congrats on the quarter. Not to stir the pot here, Adam. I just want to understand. Can you just confirm that could we see clearance of Thunderbolt ahead of a possible data presentation at SVIN in November? Is that within the realm of possibilities?
Adam Elsesser: Yeah. I again, I totally appreciate the question. I don't think you're stirring the pot at all. I don't mean to answer the question the way I've answered the last two or three times, but we're in an active process. Obviously, I don't control it. We're going through that process, and it's what we expected. And as soon as we can, we will tell you something. Okay. I can't say more than that. I think it's pretty obvious. So but I have a lot of respect for the various attempts to get me to say something else.
Ryan Zimmerman: That's fine. I'll stick just two more around neuro. One know, I was also at SNAS. You know, we saw that distal trials early in February at ISC. Do you think you need to do a distal aspiration trial? Because, clearly, all three of those trials were with stent retrievers. And, you know, we saw a subgroup analysis on aspiration in M2, and, you know, clearly, it was effective. So know, is a distal trial necessary to kind of reinvigorate that market? And then the second part of the question, is just what do you consider successful in the Thunderbolt trial?
Because you know, if revascularization immediate revascularization is the endpoint, you know, I guess, what do you consider kind of a good time reduction that we should be looking for in that trial? Thanks for taking my question.
Adam Elsesser: Yeah. Both really, really good questions. Let's start on the distal one. You know, there's a lot of discussion in SNIS just sort of prompted it. You know, we hosted a symposium dinner symposium. We hugely intended probably one of our biggest attended ones we've ever had at SNIS. So there's a lot of interest in this topic of distal. And there's not an easy answer. There's not a lot of consensus. I think people would not mind having data that you know, is directly supportive of our RED43 catheter doing this, which is really considered the sort of catheter of choice to do these cases. What does that trial look like?
You know, who would randomize for people who already believe in it? No one is gonna wanna randomize those patients because they already believe it. So I think it's a tricky trial, but there's a lot of conversations that are happening. We're privy to most of them. About what is next and what should be done here, and we'll let you know when there's some additional information to share. But, yeah, I agree with you that it's an open question. Do we need it? And then the question around what the Thunderbolt study should show, I'm not gonna answer that quantitatively, obviously, but I will just sort of point to the thing that Thunderbolt does.
So Thunderbolt is not the catheter. Thunderbolt is this the product that attaches to the catheter and to our aspiration source. And creates modulated aspiration. So its only work is done when the catheter's already at the face. The clot and it's about how fast the clot can come out. The not the case itself time, but the clot removal time. So that's what we want to measure. Obviously, we have all the traditional endpoints that the trials have, but that's the thing that physicians are gonna be looking for. Does that change?
And that there's no standard for people but if you talk to as many physicians as I talk to, everyone kind of has their own gut feel of what their average time is, you know, not their best time, which they share with most people, but their actual average time. When you look at, you know, hundreds of cases. And that's what I think we'll be measuring up against.
Ryan Zimmerman: Thank you. Congrats on the Thank you.
Adam Elsesser: Yeah. Thank you.
Operator: And our next question comes from the line of Michael Sarcone with Jefferies.
Michael Sarcone: A few things going on here. You know, you have the Salesforce ramping. You're ramping Ruby Excel, and you also mentioned you're moving past some China headwinds. Do you think maybe just in the context of guidance, can you talk about how you're thinking about seasonality and quarterly cadence through the back half of the year?
Adam Elsesser: You know, obviously, there's traditionally been a sequential gain from you know, unless there's some unusual thing like product launches or something. That change that between, you know, user build a little in the third quarter and ramp into the fourth quarter so that is, you know, the fourth quarter is always the best unless, again, that's something changes because of product launches. And so I expect that to be somewhat the same here now. Yeah. And that's just been that way forever.
Michael Sarcone: Okay. Great. And second question is just, you know, on the USB C business, really strong growth the past three quarters. You mentioned, know, obviously, the market's not growing at that level. Think maybe you can just give us an update on where you stand on the market share front? In pulmonary embolism and DVT?
Adam Elsesser: You know, we all try to guess based on all the data sources that everyone gets. I think it's always sort of a fool's errand to put an exact number on it. We have obviously continued to gain share both in DVT and PE. I think we've made enough movement in DVT to be, you know, over 50%. And I think we've made a pretty significant dent in the PE business. I'm pretty excited about the cases we've seen, the excitement around that, from new users. And I think, you know, if STORM PE is positive, you know, that will simply continue if not accelerate. So I think we're in pretty good shape. Again, it comes down to the product.
It is a product that just does what it's supposed to do simpler and faster and safer than other technologies. And at the end of the day, I think I've always said, you know, almost all doctors will ultimately use the best product. And I think that's just what we're seeing right now. That the proprietary sort of, you know, computer-assisted vacuum, therm vacuum, your CAVT, is just a unique animal that isn't really something that anyone else can do and copy because of obviously, IP, and we're in pretty good shape with it. And we're not done. We're gonna keep making it better, and I think everyone knows that.
Michael Sarcone: Great. Thanks, Adam.
Adam Elsesser: Thank you.
Operator: And our next question comes from the line of Joanne Wuensch with Citi. Line is open. Thank you for taking the question. And congrats on the quarter. I'd like to spend just a minute on STORM PE with the announcement of the completion of enrollment. It seems to me that this is sort of the next wave of growth for you. And with the enrollment being completed, can you walk us through the time frame to get from here to approval to commercialization? And if there's anything specific that we should be aware of on that path. Thank you so much.
Adam Elsesser: Yeah. No. Thank you. It's a great question. Well, first of all, our product is already cleared, for use in PE. So there's no approval or clearance necessary here. Which is great. It really is just data that is gonna be looked at by the larger community, not just interventionalists, but everyone involved in the treatment of PE cases, of patients, to determine what the best treatment for these patients is. And again, this is the first trial in the world that has finished that compares anticoagulation to anticoagulation and a mechanical device, in this case, our specific mechanical device. So I think that's what is driving the excitement because that's standard of care versus something new.
And I think if the trial is positive, it will obviously have some significant impact on the thinking around the pay the physicians who are charged with caring for these patients and their referral patterns and what they want to do with these patients. And, again, to remind everyone, we're, you know, we're 10 plus percent penetrated this market just in The US. So there's a lot more patients that can benefit. And, again, if the trial's positive and shows that, I think it will have some significant impact.
Again, on a market that you know, is you know, all in bigger, you know, than our stroke market, so it's a huge impact and a huge win for potentially lots of patients, again, assuming the trial is positive.
Joanne Wuensch: Thank you.
Adam Elsesser: Thank you.
Operator: And our next question comes from the line of Matthew O'Brien with Piper Sandler. Your line is open.
Samantha Kurtz: Hi. This is Samantha on for Matt. Thank you so much for taking our question. I guess we'd like to continue that train of thought with STORM PE. And, you know, assuming the data is positive and we definitely think it will be, you know, how do you anticipate the market evolving? You know, is it appropriate to think of it like stroke where you saw this almost immediate increase in thrombectomy usage after the readout?
Adam Elsesser: Yeah. It's we don't know. So let's wait till we get the data and present it this fall, which isn't that far away. That being said, the one thing that I want to point out that's different about stroke, and this is somewhat important, with stroke, you had and still have what I alluded to earlier, this fundamental structural problem in that the patients aren't always going to a hospital that does you know, stroke intervention treatment. So sometimes they have to be moved, are they always moved? That is a structural impediment. You don't really have that in PE. You know, there's gotta be, you know, some hospital, one, you know, place here or there where maybe that's true.
But the vast, vast majority of places where a patient will show up with a PE they could be treated if that is becoming the standard of care. So it's a very, very different dynamic and it's something that having you know, spent the better part of ten years sort of working on, I'm incredibly excited to not have that impediment and be able to just do the right thing for all these patients. Again, assuming it's positive.
Samantha Kurtz: Right. Yeah. Thank you so much for that. It makes a lot of sense. And then just we have one follow-up on the neurovascular thrombectomy market and specifically, I guess, kind of what the medium vessel occlusion, I guess, portion of the market is doing. You know, I guess, could you talk a little bit about your exposure? Maybe what percent of your stroke business happens in these medium best occlusions. And what revenue, if any, is impacted?
Adam Elsesser: Yeah. It's, that's a really, really good question. It's hard to pinpoint that exactly because, you know, if you take the medium, if you as you call it, are catheters that would typically be used there. Are a Red 62 and sometimes a Red 43. Both catheters are also used in other places, so it's hard for us to know and pinpoint that you know, with the kind of numerical precision that I would like and you probably want. What I can tell you is it really is very much a site-specific thing, and it isn't just the interventionist making those decisions. In fact, most of the time, it's a non-interventionalist making those referral patterns. It has happened.
We have heard of centers that have become more conservative. I don't think it's the overwhelming view, and obviously, you know, we did really quite well this quarter. It continued to take share. You know, the overall market didn't grow as much, and could that have had some small impact on that number potentially? But we don't know that definitively.
Samantha Kurtz: Okay. That's helpful. Thank you. I appreciate it.
Adam Elsesser: Yeah. Thank you.
Operator: And our final question comes from the line of Chris Pasquale with Nephron. Your line is open.
Chris Pasquale: Thanks. I wanted to circle back to international embolization, just given how much that segment drove the upside this quarter and really deviated from the recent trend both sequentially and year over year. First, Adam, if you wouldn't mind, could you quantify the China contributions just so we can tell the extent to which that order might have driven the beat? And then second, I think your original guidance for the year called for international AMBO to be about flat. For The US to be up to maybe mid to high single digits. Both pieces are running ahead of that midway through. So how are you thinking about the full-year growth for that business?
Adam Elsesser: Yeah. Let me well, let me first of all, I'm trying to they don't order any of our coils, so it has nothing to do with our AMBO number at all. As it relates to the larger you know, the larger thing I mean, they have some access products. They have some stroke, you know, products and thrombectomy products rather. As it relates to the larger international business, I think you know that we have been in a rebuilding mode, you know, for a year and a half. I think we've been pretty open about that process as we want to sort of get the right products there.
We want to be at a margin that is affordable in markets that do that. And I think what we're seeing is the benefit of a lot of that work. And I'm pretty excited to see that work. You know? It's easy to focus on our US business where there's so much good happening there, but it's also really important that we don't forget about the rest of the business, and I'm excited that we can do all of it at once. And I think, you know, again, none of this is linear, but I think we're in pretty good shape for a while.
As we move into, you know, not just this year, but in prior you know, future years. Both in our US, but also internationally.
Chris Pasquale: K. Thank you.
Adam Elsesser: Thank you.
Operator: And ladies and gentlemen, that concludes our question and answer session. At this time, I would like to turn the call back over to Ms. Furlong for closing remarks.
Cecilia Furlong: Thank you, operator. On behalf of our management team, thank you all again for joining us today and for your interest in Penumbra. We look forward to updating you on our third-quarter call.
Operator: And this concludes today's call, and we thank you for your participation. You may now disconnect.