Q4 2024 TriSalus Life Sciences Inc Earnings Call
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Unknown Executive: Good morning and welcome to TriSalus Life Sciences fourth quarter and full year 2024 earnings conference call. Currently, all participants are in a listening mode. We will be facilitating a question and answer session toward the end of today's call. As a reminder, this call is being recorded for replay purposes.
Speaker Change: Good morning, and welcome to Tri salaries, Lifesciences fourth quarter and full year of 2024 earnings conference call.
Currently all participants are in a listen only mode.
Speaker Change: We'll be facilitating a question and answer session towards the end of today's call.
Speaker Change: As a reminder, this call is being recorded for replay purposes.
Unknown Executive: I would now like to turn the call over to Jeremy Pfeffer.
Jeremy Fastener: I'd now like to turn the call over to Jeremy Jeremy Fastener.
Speaker Change: Yeah.
Unknown Executive: Thank you all for participating in today's call.
Jeremy Fastener: Thank you all for participating in today's call joining me today from Tristylous Life Sciences are marries our president and Chief Executive Officer, and James Young Chief Financial Officer.
Unknown Executive: Joining me today from TriSalus Life Sciences are Mary Szela, President and Chief Executive Officer, and James Young, Chief Financial Officer.
Unknown Executive: Earlier this morning, TriSalus released financial results for the fourth quarter and full year ended December 31st, 2024. A copy of the press release is available on TriSalus website.
Jeremy Fastener: Earlier. This morning, <unk> released financial results for the fourth quarter and full year ended December 31, 2020 for a copy of the press release is available on Tristylous website.
Unknown Executive: Before we begin, I would like to remind you that management will make statements during this call that includes forward-looking statements within the meaning of federal securities laws, which are pursuant to the safe harbor provisions of the Private Securities Reform Act of 1995. Any statements contained in this call, other than the statements of historical fact, are forward-looking statements. All forward-looking statements, including without limitation, statements relating to our sales and operating trends, business and hiring prospects, financial and revenue expectations, the timing of the filing of our annual report in Form 10-K, and future product development and approvals are based upon our current estimates and various assumptions.
Jeremy Fastener: Before we begin I would like to remind you that management will make statements. During this call that includes forward looking statements within the meaning of federal Securities laws, which are pursuant to the safe Harbor provisions of the private Securities Reform Act of 1995 any statements contained in this call other than statements of historical fact are forward looking statements.
Jeremy Fastener: Looking statements, including without limitation statements relating to our sales and operating trends business and hiring prospects financial and revenue expectations. The timing of the filing of our annual report and Form 10-K, and future product development and approvals are based upon our current estimates and various assumptions. These statements involve material risks and.
Unknown Executive: These statements involve material risks and uncertainties, including the impact of macroeconomic conditions and global events that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements.
Jeremy Fastener: Uncertainties, including the impact of macroeconomic conditions and global events that could cause actual results or events to materially differ from those anticipated or implied by these forward looking statements.
Jeremy Fastener: Accordingly, you should not place undue reliance on these statements for a list and description of the risks and uncertainties associated with our business. Please refer to the risk factors section of our Form 10-Q on file with the SEC and available on Edgar and in our other reports filed periodically with the SEC.
Unknown Executive: For a list and description of the risks and uncertainties associated with our business, please refer to the risk factors section of our Form 10-Q on file with the SEC and available on EDGAR and in our other reports filed periodically with the SEC. TriSalus disclaims any intention or obligation except as required by law to update or revise any financial projections or forward-looking statements, whether because of new information, future events, or otherwise.
Jeremy Fastener: <unk> disclaims any intention or obligation, except as required by law to update or revise any financial projections or forward looking statements, whether because of new information future events or otherwise. This conference call contains time sensitive information and is accurate only as of the lifeblood cast today March 27th 2025.
Unknown Executive: This conference call contains time-sensitive information and is accurate only as of the live broadcast today, March 27, 2025.
Mary Szela: And with that, I'll turn the call over to Mary. Good morning, everyone, and thank you again for joining today's call. In 2024, TriSalus executed decisive, strategic moves to position the company for long-term success. Recognizing the strong commercial potential of our pressure-enabled drug delivery technology, driven by its favorable reimbursement advantages, pipeline expansion opportunities, and broader utilization in new clinical applications, we prioritized our technology platform while preserving future upside for Nelatolamide through a potential partnership and a focused pancreatic indication strategy. This strategic shift significantly reduced R&D expenses while establishing a clear path to EBITDA positivity by mid-2025 and cash flow positivity by year-end.
Mary: That I will turn the call over to Mary.
Mary: Good morning, everyone and thank you again for joining today's call and 2024 <unk> executed decisive strategic moves to position the company for long term success, recognizing this strong commercial potential of our pressure enabled cut delivery technology driven by its favorable reimbursement.
Mary: Advantages pipeline expansion opportunities and broader utilization and new clinical applications, we prioritize our technology platform, while preserving future upside for <unk> through a potential partnership and a focused pancreatic indications strategy.
Mary: This strategic shift significantly reduced R&D expenses, while establishing a clear path to EBITDA positivity by mid 2025 and cash flow positivity by year end.
Mary Szela: Despite a challenging economic environment, TriSalus maintains strong commercial momentum, expanding our PEDD technology into new clinical applications. Today, I'll walk through our quarterly results and highlight our achievements over the last year, which has set the stage for continued growth. Notably, we achieved 44% growth in the fourth quarter and 59% operational growth for the full year, marking another strong quarterly performance in a high-growth year. We remain committed to executing our growth strategy, which includes advancing our pipeline, expanding PEDD clinical applications, improving our manufacturing efficiencies and gross margins, and evolving our organization to sustain high growth. We are confident that these efforts will position us to drive 50% plus top line revenue growth and in 2025, an even greater patient impact and financial success in the future.
Mary: Despite a challenging economic environment <unk> maintained strong commercial momentum expanding our pega technology into new clinical applications today I'll walk through our quarterly results and highlight our achievements over the last year, which has set the stage for continued growth, notably we achieved.
Mary: 44% growth in the fourth quarter, and 59% operational growth for the full year, marking another strong quarterly performance in a high growth year.
Mary: We remain committed to executing our growth strategy, which include advancing our pipeline expanding ped clinical applications.
Mary: Proving our manufacturing efficiencies and gross margin and evolving our organization to sustained high growth.
Mary: We are confident that these efforts will position us to drive 50% plus top line revenue growth and in 2025, and even greater patient impact and financial success in the future.
Mary Szela: Now let me outline the 2024 accomplishments. TriSalus achieved $29.4 million in net sales, reflecting a 59.4% growth over 2023, reinforcing our status as one of the fastest growing medtech companies. TriSalus focused on using our PEDD technology to improve outcomes for complex patients. Clinical studies in TACE and CARE demonstrated that our technology approach enhances therapeutic delivery while reducing off-target effects on healthy tissue. Our health economic and outcome research study highlighted that Trinab is predominantly used in high disease burden patients, leading to comparable outcomes to those with lesser disease burden and better transplant success rates. TriSalus increased the number of unique ordering accounts by 43% year-over-year from 199 to 284.
Mary: Now, let me outline the 2024 accomplishments.
Mary: <unk> achieved $29 4 million in net sale, reflecting a 59, 4% growth over 2023, reinforcing our status as one of the fastest growing med tech companies.
Mary: Alex focused on using our <unk> technology to improve outcomes for complex patients clinical studies in taste and Ter demonstrated that our technology approach enhances therapeutic delivery, while reducing off target effects on healthy tissue.
Mary: Our health economic and outcome research study highlighted the <unk> is predominantly used in high disease burden patients.
Mary: Leading to comparable outcomes to those with lesser disease burden and better transplant success rates.
Mary: <unk> increased the number of unique ordering accounts by 43% year over year from 199 to 284.
Mary Szela: Account utilization also improved, with average units sold per ordering account rising 10% from 12.3 to 13.5 units. Additionally, we opened up 103 new accounts, nearly doubling the 55 new accounts added in 2023. These new accounts contributed 19.5% of the total 2024 sales.
Mary: Count utilization also improved with average unit sold per ordering account rising 10% from 12, 3% to $13 five units. Additionally, we opened up a 103 new accounts nearly doubling the 55 new accounts added in 2023. These new accounts contributed $19 five.
Mary: 5% of the total 2020 for sale.
Mary Szela: The PROTECT Registry Study is evaluating TRINAB for nonmalignant thyroid goiters and nodules. The study is enrolling 100 patients across over 10 academic sites. Nonmalignant thyroid goiters and nodules represent a market of approximately 50,000 annual procedures and a 400 million incremental opportunity for TRINAB. The procedure is already eligible for our existing HCPCS reimbursement code, streamlining future adoptions. We also published additional real-world HEOR studies leveraging our 300 million patient records, which covers over 98% of U.S. payers. The latest analysis, which was an additional year, compares 603 PEDD patients with 16,210 non-PEDD patients. These results confirmed improved patient outcomes, including lower post-procedure fatigue rates.
Speaker Change: The protect registry study is evaluating China for non malignant thyroid quarters and not all the studies enrolling 100 patients across over 10 academic sites non malignant thyroid nodules represent a market of approximately 50000 annual procedures and a 400 million.
Speaker Change: An incremental opportunity for China. The procedure is already eligible for our existing expense reimbursement code streamlining future adoption.
Speaker Change: We also published additional real World HCR studies, leveraging our 300 million patient records, which covers over 98% of U S. Payers. The latest analysis, which was an additional year comparing 603 p/e patients with 16000.
Speaker Change: 210, non ped patients.
Speaker Change: These results confirmed improved patient outcome, including lower post procedure fatigue right.
Mary Szela: better chemotherapy delivery and fewer complications in HCC and TAIR patients. We also received recent news from CMS that they issued a new code, HCPCS code C8004, for simulation or mapping procedures using TRINAB. This now becomes effective on April 1st, 2025. This reimbursement code ensures financial support for clinicians using TRINAB in Medicare treatment planning.
Speaker Change: Better chemotherapy delivery and fewer complications in HCC and tier patients.
Speaker Change: We also received recent news from CMS that they issued a new code Hicks picks code C 8004 for stimulation or mapping procedures using trying out. This now becomes effective on April one 2025, this reimbursement code insurer's financial support.
Speaker Change: For clinicians using try Nab and Medicare treatment planning.
Mary Szela: The launch of TriNav LV Infusion System and TriGuide Guiding Catheter expanded our PEDD portfolio. These innovations optimize therapeutic delivery, improve procedural efficiency, and expand our addressable market and offer physicians a full range of vessel size for any embolization procedure. Additionally, TriSalus completed Phase I clinical trials for Nelatolimod in uveal melanoma liver metastases, HCC, and intraepatic cholangiocarcinoma utilizing PEDD. We are actively seeking strategic partnerships to advance this program in uveal melanoma liver metastases. Additionally, we completed enrollment in the PERI-03 Phase I trial investigating Nelatolimod in locally advanced pancreatic cancer. Final data is expected mid-2025, and we will determine next steps based on those results.
The launch of China, Lv infusion system, and Tri guide guiding catheter expanded our <unk> portfolio.
Speaker Change: These innovations optimized therapeutic delivery improved procedural efficiency and expand our addressable market and offer physicians a full range of vessel size for any embolization procedure.
Speaker Change: Additionally, <unk> completed phase one clinical trials for <unk> in Uveal melanoma liver metastasis HCC in intrahepatic Cholangiocarcinoma utilizing ped.
Speaker Change: We are actively seeking strategic partnerships to advance this program in Uveal melanoma liver metastases.
Speaker Change: Additionally, we completed enrollment in the <unk> three phase one trial investigating <unk> in locally advanced pancreatic cancer final data is expected mid 2025.
Speaker Change: And we will determine next steps based on those results.
Mary Szela: TriSalus also secured up to $50 million in debt financing from OrbaMed to support TriNav Growth Initiative with $35 million access to date. Our cash runway extends through 2025. And our Westminster site supported Trinab Large and TriGuide launches in Q3 2024, and is preparing for launch of Trinab 2.0 in the first half of 2025. A clean room expansion is set for Q1 2025, and this will increase manufacturing capacity. TriSalus is poised for continued growth in 2025, driven by our strategic priorities, which include deeper penetration of the complex liver embolization market, expanded reimbursement for radio embolization mapping, the launch of a more trackable TRiNAV 2.0, enhanced health economic and outcome research data and new clinical study presentations at SIR, and our phase one clinical trial data reveal for melatolamide in combination with our novel pancreatic infusion technology.
Speaker Change: <unk> also secured up to $50 million in debt financing from <unk> to support <unk> growth initiative with 35 million excess today, our cash runway extends through 2025.
Speaker Change: And our Westminister sites supported China of large and tried to try guide launch. It in Q3 2024 and is preparing for launch of China to now in the first half of 2025.
Speaker Change: Our clean room expansion is set for Q1 2025, and this will increase manufacturing capacity.
Speaker Change: <unk> is poised for continued growth in 2025, driven by our strategic priorities, which include deeper penetration of the complex liver embolization market.
Speaker Change: Expanded reimbursement for radio embolization mapping.
Speaker Change: Want to have a more trackable try now to point al enhanced health economic and outcome research data and new clinical study presentations at <unk>.
Speaker Change: In our phase one clinical trial data reveal for melanoma in combination with our novel pancreatic infusion technology.
Mary Szela: We believe TRINAB has the potential to become the standard of care for complex embolization patients. Our focus will remain on strengthening clinical evidence, executing targeted educational initiatives, and working toward inclusion in society guidelines.
Speaker Change: We believe <unk> has the potential to become the standard of care for complex embolization patients. Our focus will remain on strengthening clinical evidence executing targeted educational initiatives and working toward inclusion and society guidelines.
Mary Szela: I'll close by reiterating our 2025 guidance, which reflects 50% plus revenue growth, along with positive full year EBITDA and cash flow in the second half of 2025. We are a science-driven company with a steadfast commitment to keeping patients at the center of everything we do. Our advancements make a meaningful difference for those suffering from liver, pancreatic, and other solid tumors. In 2024, we've made significant progress in expanding the commercialization of TRINAB, advancing our technology pipeline, including melatolamide in combination with TRINAB, and strengthening our overall operations. With a focus on operational and strategic excellence, I'm confident in our ability to drive continued growth for TriNav, advance our pipeline, and deliver both short-term and long-term value for our shareholders.
Speaker Change: I'll close by reiterating our 2025 guidance, which reflects 50% plus revenue growth.
Speaker Change: Along with positive full year, EBITDA and cash flow in the second half of 2025.
Speaker Change: We are a science driven company with a steadfast commitment to keeping patients at the center of everything we do our advancements make a meaningful difference for those suffering from liver pancreatic and other solid tumors.
Speaker Change: In 2024, we've made significant progress in expanding the commercialization of China advancing our technology pipeline.
Including melanoma in combination with China, and strengthening our overall operations.
Speaker Change: With a focus on operational and strategic excellence I'm confident in our ability to drive continued growth for China and advance our pipeline and deliver both short term and long term value for our shareholders. Most importantly, my confidence comes from my team their dedication to patients commitment to our mission and remove.
Mary Szela: Most importantly, my confidence comes from my team, their dedication to patience, commitment to our mission, and relentless pursuit of innovation.
Mary Szela: I want to express my sincere gratitude to our employees and shareholders. for their unwavering support. I look forward to sharing future updates on our progress and impact.
Speaker Change: Nonetheless pursuit of innovation I want to express my sincere gratitude to our employees and shareholders.
Speaker Change: For their unwavering support I look forward to sharing future updates on our progress and impact now I will turn it over to our CFO Jim Young.
James Young: Now, I'll turn it over to our CFO, Jim Young. Good morning, everyone, and thank you, Mary.
Jim Young: Good morning, everyone and thank you Mary.
James Young: As noted in our press release, TriSalus will soon file a Form 12-B25 notification of late filing with the SEC related to the company's annual report on Form 10-K for 2025. This filing provides the company an extension of up to 15 days to file its annual report. If the company files its annual report within such 15-day period, the annual report will be deemed to have been filed timely.
Jim Young: As noted in our press release <unk> will soon file a form <unk> 25 notification of late filing with the SEC related to the Companys annual report on Form 10-K for 2024.
Jim Young: This filing provides the company an extension of up to 15 days to file its annual report if the company filed its annual report within such 15 day period. The annual report will be deemed to have been filed timely the company filed form <unk> 25, due to errors identified in determining stock based compensation in there.
James Young: The company filed Form 12B25 due to errors identified in determining stock-based compensation and the timing of clinical trial-related R&D expenses in 2024. As a result, the operating results provided on the call today are unaudited and subject to potential adjustment.
Jim Young: Timing of clinical trial related R&D expenses in 2024 as a result, the operating results provided on the call today are unaudited and subject to potential adjustments.
James Young: Despite this administrative delay, TriSalus delivered strong operational performance in the fourth quarter, ending December 31, 2024. Revenue, driven solely by the continued success of the TriNav device in the US, reached $8.3 million, representing a 44% increase compared to the same period in 2023, and a 12% sequential increase from the third quarter. As illustrated on slide 1, TriSalus has maintained a robust growth trajectory, achieving a compound annualized growth rate of approximately 50% since the product's launch in 2020. In terms of full year revenues, in 2024, we have reached $29.4 million, a 59% increase from the prior year.
Jim Young: Despite this administrative delay try sales delivered strong operational performance in the fourth quarter ending December 31 2024.
Jim Young: Revenue driven solely by the continued success of the <unk> device in the U S.
Jim Young: <unk> $8 3 million, representing a 44% increase compared to the same period in 2023, and a 12% sequential increase from the third quarter.
Jim Young: As illustrated on slide one tries salus has maintained a robust growth trajectory achieving a compound annualized growth rate of approximately 50% since the product's launch in 2020.
Jim Young: In terms of full year revenues in 2024, we have reached $29 4, million% to 59% increase from the prior year.
James Young: These results can be attributed to several factors, including the adoption of TRINAB and new accounts, increased utilization of existing accounts, and the continued expansion of our sales force, all of which have led to an increase in our market share for 2024 to 9% of the liver taste and tear procedure. These factors, as well as our favorable reimbursement and real world evidence data, allow us to forecast 2025 growth in excess of 50%. In 2024, we captured 103 new hospital accounts year to date. Our account utilization reached 13.5 units per account, an increase of 1.2 units, or 10% over the prior year.
Jim Young: These results can be attributed to several factors, including the adoption of <unk> and new accounts increased utilization of existing accounts and the continued expansion of our sales force all of which have led to an increase in our market share for 2024% to 9% of the liberties and tear procedures.
Jim Young: These factors as well as our favorable reimbursement and real world evidence data allow us to forecast 2025 growth in excess of 50%.
Jim Young: In 2024, we captured 103, New hospital accounts year to date, our account utilization reached $13 five units per account an increase of $1 two units or 10% over the prior year.
James Young: We are proud to report a robust gross margin profile of 85% in the fourth quarter of 2024 and 86% for the full year, compared to 90% in the fourth quarter and 86% for the full year in 2023.
Jim Young: We are proud to report a robust gross margin profile of 85% in the fourth quarter of 2024, and 86% for the full year compared to 90% in the fourth quarter and 86% for the full year in 2023, we believe our facility in Westminster, Colorado has the capacity to support our growth over the next.
James Young: We believe our facility in Westminster, Colorado has the capacity to support our growth over the next five years with minimal capital investment. In terms of our investments in research and development, expenses for the fourth quarter of 2024 totaled $3 million, a decrease of 62% from the fourth quarter of 2023. Full year R&D expenses amounted to $17.7 million, reflecting a 41% decrease from the corresponding period in 2023. We expect our clinical costs in 2025 to continue to decrease due to completion of melatolamide patient enrollment in all periostudies.
Jim Young: Five years with minimal capital investment.
Jim Young: In terms of our investments in research and development expenses for the fourth quarter of 2024 totaled $3 million a decrease of 62% from the fourth quarter of 2023.
Jim Young: Full year R&D expenses amounted to $17 7 million, reflecting a 41% decrease from the corresponding period in 2023.
Jim Young: We expect our clinical costs in 2025 to continue to decrease due to completion of now a total amount of patient enrollment in all periods studies.
James Young: In terms of sales and marketing, in the fourth quarter of 2024, we invested a total of $7 million, a 25% increase from the fourth quarter of 2023. Full-year sales and marketing expenses reached $25.8 million, which is a 52% increase from 2023. General and administrative expenses for the fourth quarter of 2024 totaled $4.7 million, representing a decrease of over 22% compared to the fourth quarter of 2023. Full-year general and administrative expenses of $18 million were 24% less than in 2023.
Jim Young: In terms of sales and marketing in the fourth quarter of 2024, we invested a total of $7 million or 25% increase from the fourth quarter of 2023.
Jim Young: Full year sales and marketing expenses reached $25 8 million, which is a 52% increase from 2023.
Jim Young: General and administrative expenses for the fourth quarter of 2024 totaled $4 7 million, representing a decrease of over 22% compared to the fourth quarter of 2023 full year general and administrative expenses of $18 million were 24% less than in 2023.
James Young: Our operating losses for the fourth quarter of 2024 totaled $7.6 million compared to losses of $14.2 million in the fourth quarter of 2023. Year-to-date losses in 2024 amounted to $36.2 million compared to losses of $54.5 million in 2023. The decreased losses in 2024 can be attributed to increased gross margins resulting from increased TRINAB revenues and reduced operating expenses in research and development and general administrative expenses, partially offset by increased investments in sales and marketing.
Jim Young: Our operating losses for the fourth quarter of 2024 totaled $7 6 million compared to losses of $14 2 million in the fourth quarter of 2023 year to date losses in 2024 amounted to $36 2 million compared to losses of $54 5 million in 2023.
Jim Young: The decrease losses in 2024 can be attributed to increased gross margins, resulting from increased trying to have revenues and reduced operating expenses and research and development and general and administrative expenses, partially offset by increased investments in sales and marketing.
James Young: At year-end, we have $8.5 million of cash and cash equivalents. In addition, we drew an additional $10 million from our OrbeMed debt facility in the first quarter. This amount, as well as other additional existing sources of liquidity, provide us sufficient liquidity to fund operations throughout 2024.
Jim Young: At year end, we have $8 5 million of cash and cash equivalents. In addition, we drew an additional $10 million from our <unk> debt facility in the first quarter. This amount as well as other additional existing sources of liquidity provide us sufficient liquidity to fund operations throughout 2025.
Mary Szela: And now, I'll turn the call back to Mary for closing remarks. Thank you, Jim, and to all of you participating in the call today.
Mary: And now I'll turn the call back to Mary for closing remarks.
Mary: Thank you, Jim and to all of you participating in the call today with that I'll open up the floor for any questions you may have.
Unknown Executive: With that, I'll open up the floor for any questions you may have. Thank you. As a reminder, to ask a question, please press star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A.
Mary: Thank you as a reminder to ask a question. Please press star one one of your telephone and wafer name to be announced to withdraw. Your question. Please press star one again, please standby, while we compile the Q&A roster.
Carl Burns: Our first question comes from the line of Carl Burns with Northland Capital Markets.
Mary: Our first question comes from the line of Carl Byrnes with Northland Capital markets. Your line is now open.
Mary Szela: Your line is now open. Congratulations on the progress and the results. And thanks for the question. With respect to the launch of Trinib large vessels, where are you seeing uptake? In case, are you seeing it at HCC and ICC procedures? And with tear, are you seeing it in segmental artery procedures? And if you can break it out in terms what percent is going to tase and tear.
Mary: Congratulations on the progress and the results and thanks for the question was with respect to the launch of trying to have large vessels, where are you seeing uptake and pace are you seeing at HCC and ICC procedures and with Terry Youre seeing it.
Mary: Segmental artery procedures and if you can break it out in terms of what percent is going to taste and terror.
Mary: <unk>.
Mary: Sure.
Mary Szela: And I'm also going to have our medical director, Dr. Richard Marshall jump in as well. I think he can talk about just the utilization in between case and tear. But mainly what we're seeing is a lot of the trying to have large right now. for, as you know, large vessel in low bar administration, as opposed to super selective and just larger vessel size, you know, vessels that are three and a half to four people will move to the larger vessel. Right now we're seeing it primarily in tear more than taste, but I'll have Dr. Marshall actually comment a little bit more about what he's seeing across the country as well.
Mary: I'll take this one I'm also going to have our medical director, Dr. Richard Marsal jump in as well.
Mary: I think he can talk about just the utilization between tastes and tear but mainly what we're seeing is.
Mary: A lot of the training of large right now being used for as you know large vessel and low bar administration as opposed to Super selective and just larger vessel size vessels that are three and a half to four people will move to the larger battle right now we're seeing it primarily in <unk>.
Mary: Per.
Mary: More than taste.
Speaker Change: But I'll have Dr. Marshall actually comment a little bit more about what he is seeing across the country as well.
Dr. Richard Marshall: Thanks, Mary. That's exactly right. We are seeing an increased use in larger vessel applications, which are broader treatment areas. So more low bar applications. Patients with neuroendocrine tumors tend to have larger arteries because those tumors require more blood flow. So personally, I'm seeing I'm using it more frequently in that diagnosis. Got it. Great. Thank you. That's very helpful.
Speaker Change: That's exactly right we are seeing an increased use in.
Speaker Change: Larger vessel applications, which are broader treatment area, so more low bar applications.
Speaker Change: Patients with neuroendocrine tumors tend to have larger arteries, because those tumors require more blood flow.
Speaker Change: So personally I'm seeing I'm using it more frequently and that diagnosis.
Speaker Change: Got it great. Thank you that's very helpful. And then I'm wondering if you can.
Mary Szela: And then I'm wondering if you. you know, qualify or quantify at all what what you're seeing in terms of current mapping with tear and how you see the code that was issued yesterday. Yeah, so let me start with so the code that was issued from CMS was for Medicare. I will tell you that we have people are using Trinap for both mapping and treatment in commercial and we see that pretty consistent. However, there are accounts that are concerned that because they can't get appropriate reimbursement in Medicare, they would map with just an end hole catheter and do treatment with Trinap.
Speaker Change: Qualify or quantify at all.
Speaker Change: What what Youre seeing in terms of current mapping with terror and how you see the.
Speaker Change: The code that was issued yesterday.
Speaker Change: Yes.
Speaker Change: Yes, So let me start with.
Speaker Change: So the code that was issued from CMS for Medicare.
Speaker Change: I'll tell you that we have people are using trying out for both mapping and treatment in commercial patients and we see that pretty consistent. However, there were there are accounts that are concerned that because they can't get appropriate reimbursement in Medicare they would map with Justin.
Speaker Change: And whole catheter and do treatment with China, and that's what actually caused us to go back to CMS. In fact, one of our analyst John Young from Canaccord actually read through the detailed coding language and pointed it out to us and he was correct. We went back to CMS in August and.
Mary Szela: And that's what actually caused us to go back to CMS. In fact, one of our analysts, John Young from Canaccord, actually read through the detailed coding language and pointed it out to us, and he was correct. We went back to CMS in August and we showed them, we had thought when we worked with CMS originally that mapping was included in the original code, our C9797, but if you looked at the specific coding language, it needed to be separate and different. And so we went back to CMS, they agreed, we felt that we both made a mistake and they agreed to issue a new code.
Speaker Change: We show them, we had thought when we worked with CMS. Originally that mapping was included in the original code. Our CNET 90, 797, but if you looked at the specific coding language it needed to be separate and different and so we went back to CMS. They agreed we felt like we both made a mistake.
Speaker Change: And they agreed to issue a new code and so now with the new Medicare code will be able to address those people who were concerned about being able to use it in Medicare patients two and now we will be able to have them use it in both mapping and treatment.
Mary Szela: And so now with the new Medicare code, we'll be able to address those people who were concerned about being able to use it in Medicare patients too. And now we'll be able to have them use it in both mapping and in treatment. So now we'll be able to get the full market. About 74% of our payer mix is commercial. So we didn't have an issue with mapping in those patients, but we did not have mapping in the Medicare patients. So it opens up about another 25% of the market. And essentially what CMS did is, our current reimbursement for treatment is unaffected.
Speaker Change: Now, we'll be able to get the full market about 74% of our payer mix is commercial so we didn't have an issue with mapping in those patients, but we did not have mapping in the Medicare patients. So it opens up about another 25% of the market and essentially what CMS did is.
Speaker Change: Our current reimbursement for treatment is unaffected what they did is they wanted to make sure. They gave us a new code that covered the cost of trying out. So the hospital costs were fully covered does that help.
Mary Szela: What they did is they wanted to make sure they gave us a new code that covered the cost of TRINAB. So the hospital's costs were fully covered. Does that help? Absolutely. And that's great. Thanks so much. Thank you.
Speaker Change: Absolutely.
Speaker Change: That's great. Thanks, so much.
Justin Walsh: Our next question comes from the line of Justin Walsh with Jones Trading. Your line is now open. Hi, thanks for taking the questions.
Thank you. Our next question comes from the line of Justin Awash with Jones trading your line is now open.
Justin Awash: Hi, Thanks for taking my questions can.
Unknown Executive: Can you provide provide us with some color on what we should be looking for in the perio 03 data and and relate to this, should we be comparing these results to systemic chemo or are there other benchmarks?
Speaker Change: Can you provide us provide us with some color on what we should be looking for in the <unk> III data and unrelated to this should we be comparing these results to systemic chemo or are there other benchmarks that make more sense.
Unknown Executive: No, I can take that.
Justin Awash: No I can take that.
Unknown Executive: You know, this is just to remind everybody, this was a phase one dose ranging study in very sick patients. These were patients who were post third line, fourth line, and it was monotherapy only. So this won't be compared to chemo.
Speaker Change: Just to remind everybody. This was a phase one dose ranging study.
Speaker Change: And in very sick patients. These are patients who were post third line fourth line and it was mono therapy only so this is won't be compared to chemo and what our goal was this was the first time, we ever actually used our new technology that delivers therapy.
Unknown Executive: And what our goal was, this was the first time we ever actually used our new technology that delivers therapeutics through the venous vasculature into the pancreatic tumor. So the goal of the phase one study was number one, is this technology successful? Do we feel like it's safe? And I think we were very, very comfortable with that. We did close to 40 different infusions with this and the technology works. The results that we're comparing and waiting for is just seeing how patients progress on therapy. And right now I don't have the final results. Patients were enrolled all the way up until December.
Speaker Change: Through the venous vasculature into the pancreatic tumor so the goal of the phase. One study was number one is the technology.
Speaker Change: Successful do we feel like safe and I think we are very very comfortable with that we did close to 40 different infusions with this and the technology works.
Speaker Change: The results that we're comparing and waiting for is just seeing how patients progressed on therapy and right now I don't have the final results patients were enrolled all the way up until December and so the inclusion criteria that these patients minimally had to have more than six months of life expectancy. So we wanted to ensure.
Unknown Executive: And so the inclusion criteria that these patients minimally had to have more than six months of life expectancy. So we want to ensure that patients are on therapy and exposed to Nelatolamide for minimally six months.
Speaker Change: That patients are on therapy and exposed to <unk> for minimally six months that we're waiting for those final patients and that data to come and then we'll close the database and hope to reveal that in the middle of the year does that help.
Unknown Executive: So we're waiting for those final patients and that data to come and then we'll close the database and hope to reveal that in the middle of the year. Does that help? Yes, yes, it does.
Speaker Change: Yes, yes, it does and I'm just wondering.
Unknown Executive: And I'm just wondering if you can provide any commentary, obviously not specific details, but just the level of interest that you're seeing in your partnership discussions for Nelatolamod and the UMLM. Yeah, so, you know, it's interesting. I just came back from a big meeting where I had an opportunity to talk to quite a bit of pharma companies. And, you know, I'll tell you, I think there is, there was quite a bit of interest, and it was mainly around the fact that melatolamide has impact in terms of reducing myeloduride suppressor cells. We have not shared data with them yet.
Speaker Change: If you can provide any commentary obviously not specific details, but just the level of interest that youre seeing.
Speaker Change: And your partnership discussions for <unk> in the U M. L M patients.
Speaker Change: Yeah. So it's interesting I just came back from a big meeting, where I had an opportunity to talk to quite a bit of pharma companies and.
Speaker Change: I'll tell you I think there is there was quite a bit of interest.
Speaker Change: And it was mainly around the fact that <unk> has impact in terms of reducing myeloid derived suppressor cells.
Speaker Change: Not shared data with them yet we're still closing the database and finalizing the CSR, we hope to do that in the next month or so and then we will set up all of our meetings for people to review. So I was actually surprised I thought there was a lot more interest in what I imagined.
Unknown Executive: We're still closing the database and finalizing the CSR. We hope to do that in the next month or so. And then we'll set up all of our meetings for people to review. So I was actually surprised. I thought there was a lot more interest than what I imagined.
Unknown Executive: Great. Thanks for taking the question.
Speaker Change: Great. Thanks for taking the questions.
Unknown Executive: Thank you.
Frank Takinen: Our next question comes from the line of Frank Takinen with Lake Street Capital Markets.
Speaker Change: Thank you. Our next question comes from the line of Frank <unk> with Lake Street Capital markets. Your line is now open.
Unknown Executive: Your line is now open. All right, thanks for taking the questions. I was hoping to start with one around the guide. Appreciate the reiteration of greater than 50% growth for the year. But just given we're pretty much through Q1, any color you can provide on that the obviously the OrbaMed drawdown gives us some insight into that. But given we're pretty close to the end of the quarter, any any help on Q1 and then the cadence throughout the rest of the year?
Speaker Change: Alright, thanks for taking the questions I was hoping to start with Warner on the guide appreciate the reiteration of greater than 50% growth for the year, just given where we're pretty much through Q1 any color you can provide on that obviously, the <unk> drawdown and gives us some insight into that but given we're pretty close to the end of the quarter any any help on Q1 and then the case.
Speaker Change: Throughout the rest of the year.
James Young: Jim, do you want to take that question? Sure, I can take that. Obviously, we can't talk about Q1 at this point, of course. But I wouldn't expect it to be 50% every single quarter. It might be a little bit lumpy. But at this point, we still believe there's pretty solid opportunity for our 50% guide. So we're still happy about it for the year.
Speaker Change: Tim do you want to take that question.
Speaker Change: Sure I can take data obviously, we can't talk about Q1 at this point of course, but.
Speaker Change: I wouldn't expect it to be 50% every single quarter, it might be a little bit lumpy, but at this point, we still believe there is pretty pretty solid opportunity for 50% guide. So we're still happy about it for the year.
Unknown Executive: Okay, that's helpful.
Unknown Executive: And then maybe just on the second one was hoping to get a little more color around account openings. I think if you look at the Q3 year to date in 2024, it was about 101. And then you mentioned 103 for the full year.
Speaker Change: Okay. That's helpful. And then maybe just on the second one was hoping to get a little more color around account openings I think if you look at the Q3 year to date in 2024. It was about 101 and then you mentioned 103 for the full year can you give us some information kind of in the background maybe new.
Mary Szela: Can you give us some information kind of in the background, maybe new sites versus closed sites, and then any insight to kind of why that was only two new additions, quarter over quarter from Q3 to Q4? Yeah, that was that was very deliberate. Actually, I think we spent a lot of time in the early part of the latter part of 2023 and the early part of 2024 to opening up new accounts. And what we wanted to do was shift now to ensure that we are driving utilization in those open accounts. We had opened up so many accounts, just the timing for our reps to go back to an open account.
Speaker Change: Sites versus closed sites and then any insight kind of why that was only two new additions quarter over quarter from Q3 to Q4.
Speaker Change: Yes that was that was very deliberate actually I think.
Speaker Change: We spent a lot of time in the early part of the latter part of 2023 and the early part of 2024 to opening up new accounts.
Speaker Change: And what we wanted to do a shift now to ensure that we are driving utilization in those open accounts, we had opened up so many accounts.
Speaker Change: The timing for our reps to go back to an open account.
Mary Szela: We weren't we weren't really driving the utilization that we needed to. So now what we're trying to do is take a much more balanced approach. I think we have quite a number of new accounts open. We've gotten them through the back approval. Our big focus is driving utilization in those accounts. We'll still have a cadence of opening up new accounts and we'll do that. It won't be the magnitude of that what we did in 2022 and 23 and 24 because we're, we're at close to 284 accounts now that have been opened through back. There's about 400 hospitals that are really our top targets.
Speaker Change: We werent, we werent really driving the utilization that we needed to so now what we're trying to do is take a much more balanced approach I think we have quite a number of new accounts opened.
Speaker Change: We've gotten them through the Vac approval, our big focus is driving utilization in those accounts, we will still have a cadence of opening up new accounts and we will do that it won't be the magnitude of that what we did in 2022 and 23 and 'twenty four because where we're at close to 284 accounts now that had been opened through back Theres about four.
Speaker Change: 100 hospitals that are really our top targets our goal right now is to drive utilization.
Mary Szela: Our goal right now is to drive utilization.
Unknown Executive: Okay, that's helpful. Makes a lot of sense. Thank you.
Okay. That's helpful. Thanks, a lot thank.
Speaker Change: Thank you.
Suraj Kalia: Our next question comes from the line of Suraj Kalia with Oppenheimer and Company. Your line is now open. Hi, Mary and Jim.
Speaker Change: Thank you. Our next question comes from the line of Suraj Kalia with Oppenheimer <unk> Company. Your line is now open.
Mary Szela: This is Seamus. I'm from Suraj. Congrats on the strong end of the year and thank you for taking our questions. So, to start, I guess you kind of noted earlier with the new TriNav system mapping code, you know, it's about 25% of patients. So, I guess, can you help us understand kind of what percentage of that 25 were using TriNav for mapping before for those Medicare patients and what is, you know, I guess, remaining and what was baked into the guide, so to speak, and, you know, is there potential upside from this? Just trying to understand that those kind of dynamics.
Sheamus: Primary and Jim This is sheamus answer Suraj.
Speaker Change: Congrats on the strong end of the year and thank you for taking our questions. So.
Speaker Change: To start I guess, you kind of noted earlier with the new try NAV system mapping code, it's about 25% of patients. So I guess can you help us understand kind of what percentage of that 25 were using China for mapping before for those Medicare patients and what is.
Speaker Change: <unk>.
Speaker Change: I guess remaining and what was baked into the guide so to speak and is there potential upside from this just trying to understand that those kind of dynamics.
Mary Szela: Yeah, we don't we don't think people were using it for Medicare patients because, you know, clearly that was it was not favorable for them. So we don't believe they were. We know that patients commercial payers were paying for mapping very successfully and those customers were using it for both mapping and treatment. We did not bake mapping into our guidance at all. So we believe this would be upside because we didn't know if we were able to get a code or not. We were pretty pleased that CMS. This is, I was very, very surprised and thankful to them because we went to them in August and they issued a new code by April.
Speaker Change: Yes, we don't we don't think people are using it for Medicare patients because clearly that was it was not favorable for them. So we don't believe they were we know that patients commercial payers were paying for mapping very successfully and those customers who are using it for both mapping and treatment.
Speaker Change: We did not bake mapping into our guidance at all so we believe this would be upside.
Speaker Change: Because we didn't know if we are able to get a code or not we were pretty pleased that CMS is I was very very surprised and thankful to them because we went to them in August and they issued a new code by April that that's really incredibly and remarkably fast for CMS, having worked with them for over 30 years.
Mary Szela: That's that's really incredibly and remarkably fast for CMS having worked with them for over thirty years. So we were quite surprised that they issued it. So so quickly. We didn't think that this would happen until the end of the year. And that's why we didn't include it in our guidance. So we think this will be upside for. Got it. Appreciate that. And that's very helpful.
Speaker Change: So we were quite surprised that they issued it. So so quickly we didn't think that this would happen until the end of the year and that's why we didn't include it in our guidance. So we think this will be upside for us.
Speaker Change: Got it I appreciate that.
Unknown Executive: And then just one more from our end, on the deliver trials, you know, anything other than protect in the first half of this year, and you know, for deliver, I think, when should we expect kind of full enrollment?
Speaker Change: Very helpful.
Speaker Change: Just one more from our end on the deliver trials.
Speaker Change: Anything other than protect in the first half of this year for delivery when should we expect kind of.
Speaker Change: Full enrollment.
Dr. Richard Marshall: So, you know, maybe I'll have Dr. Marshall talk about PROTECT, we're both heading off to SIR, we have, I don't want to talk through, we plan to do some other clinical studies, and that we're just finalizing those details at SIR, and then we'll be announcing those shortly, but there's several other applications that we're going to be rolling out in the second half of the year. But Dr. Marshall, do you want to comment on PROTECT? Yes, so our PROTECT registry, which is looking at thyroid artery embolization using the TriNav catheter, is open and enrolling. We have enrolled eight patients so far.
Speaker Change: So maybe I'll have Dr. Marshall talk about protect.
Speaker Change: We're both heading off to <unk>, we have.
Speaker Change: I don't want to talk through what we plan to do some other clinical studies.
Speaker Change: And that we're just finalizing those details at S. IR and then we'll be announcing those shortly but there are several other applications that we're going to be rolling out in the second half of the year, but Dr. Marshall do you want to comment on protect yes. So our protect registry, which is looking at thyroid artery embolization using we're trying to a catheter.
Speaker Change: Is open and enrolling we have enrolled eight patients so far.
Dr. Richard Marshall: We are adding additional sites. Currently, we have one site open to enrollment, and we hope in the next few weeks to have at least one additional, if not multiple, enrolling. So I think the enrollment is going very well for that. We have planned for a one-year enrollment period for our 100 participants, but I think we're going a little bit faster than that predicted clip.
Speaker Change: We are adding additional sites.
Speaker Change: Currently we have one site open to enrollment and we hope in the next few weeks to have at least one additional if not multiple enrolling.
Speaker Change: So I think the enrollment is going very well for that we have planned for.
Speaker Change: One year enrollment period for our 100 participants, but I think we're going a little bit faster than that predicted.
Speaker Change: Clip.
Speaker Change: Yeah.
Unknown Executive: Thank you.
Speaker Change: Thank you.
Unknown Executive: As a reminder, to ask a question at this time, please press star 1-1 on your touchtone telephone.
Speaker Change: As a reminder to ask a question at this time. Please press star one on your Touchstone telephone.
William Plovanic: Our next question comes from the line of William Plovanic with Canaccord Genuity. Your line is now open. Great, thanks. Good morning.
Speaker Change: Our next question comes from the line of William <unk> with Canaccord Genuity. Your line is now open.
William: Great. Thanks, good morning.
Mary Szela: Just, you know, first question for me just is, you know, you talked about mapping being upside, kind of what is the attachment rate of, you know, mapping the cases today in commercial? We think we think it's pretty close one to one on the commercial side. You know, because one of the things that we educate physicians on I'll have Dr. Marshall talk about it. Just mapping with the same technology is just, you're going to get better outcomes, and it's also economically favorable for the accounts to do that. And so, based on the information that we see, Bill, we see that as pretty people are mapping with both with TriNav as well as treatment.
Speaker Change: First question for me just you.
Speaker Change: You talked about mapping being upside kind of what is the attachment rate of mapping the cases today in commercial.
Speaker Change: We think it's pretty close to one to one on the commercial side.
Speaker Change: Because one of the things that we educate physicians on and I'll have Dr. Marshall talk about it.
Speaker Change: Mapping with the same technology is just youre going to get better outcomes and it's also economically favorable for the account to do that and so based on the information that we see bill.
Speaker Change: We see that as pretty people are mapping with both with Tri NAV.
Speaker Change: As well as treatment.
Dr. Richard Marshall: I know Dr. Marshall, you want to comment on that just that that's something that people, you know, if they can, they'd like to do that they want to use the same technology. Yeah, I think that's exactly right. I think it's it's great to the whole point of mapping is to predict what's going to happen when we deliver a high dose of radiation. So the more we know about it, and the more we can replicate it, the better it's going to be. There are Still some people who believe that they can map with an end hole and then treat with the TriNav.
Speaker Change: Mark do you want to comment on that that's something that people if.
Speaker Change: If they can they'd like to do that they want to use the same technology.
Mark: Yes, I think thats exactly right I think it's great to the whole point of mapping is to predict what's going to happen when we deliver high dose of radiation to the more we know about it and the more we can replicate it the better it's going to be.
Speaker Change: There are.
Speaker Change: Still some people who believe.
Speaker Change: They can map with rental and then treat with.
Speaker Change: With the Tri now we've done it I think we've got a really good set of data that proves that we have correlation with mapping and treatment.
Dr. Richard Marshall: We've done it. I think we've got a really good set of data that proves that we have correlation with mapping and treatment. And now that we have this CPT code, I think anybody who is hesitant, now they know that there is an approved code for it. They're not going to be losing anything on the mapping procedure, and they're going to get better prediction of tumor doses, and really more importantly, the non-target normal liver doses, which we all want patients to live as long as they can. We don't want to treat any more of their liver than needed.
Speaker Change: And now that we have this CPT code I think anybody who is hesitant now they know that there is an approved code for it.
They're not going to be losing anything on the mapping procedure and theyre going to get better prediction of tumor doses and really more importantly than Don target normal liver doses, which we all want patients to live as long as they can we don't want to.
Speaker Change: Treat anymore of their liver than needed and so I think we have a good.
Dr. Richard Marshall: And so I think we have a good set of data supporting how we can help them.
Speaker Change: Set of data supporting how we can help them.
Mary Szela: Great, thanks. And then on, you know, pancreas, so we'll get the data sometime, probably around the third quarter, it sounds like. And then, is the next step to marry a pivotal trial? Or is it, you know, a phase two kind of have to do another trial to figure out some more, you know, specifics on whether it's dosing or treatments or what have you? And then, is that something that you're going to go alone? Or you plan on Those are all really good questions, Bill. I don't have answers for right now. I mean, we're right in the throes of, we don't have the final data set, but we have a pretty good idea.
Speaker Change: Great. Thanks, and then on pancreas, So we'll get the data sometime probably around the third quarter. It sounds like and then.
Speaker Change: Is the next step to Mary.
Speaker Change: Pivotal trial or is it.
Speaker Change: Our phase two kind of have to do another trial to figure out some more.
Speaker Change: Specifics on whether its dosing or treatments or what have you and then.
Speaker Change: Is that something that youre going to go alone or you plan on partnering.
Speaker Change: Those are all really good questions Bill I don't have answers for right now I mean, we're right in the throes of we don't have the final data set but we have a pretty good idea and we're kind of going through all of those machinations right now of what that would look like I think based on what we're seeing right now it probably would be a phase II phase III.
Mary Szela: And we're kind of going through all those machinations right now of what that would look like. I think based on what we're seeing right now, it probably would be a phase two, phase three trial. And we haven't made a decision on whether that would be something we would do alone. We think that would probably make sense to do with a partner. But we'd like to get the data first. You know, where are you in that process? It sounds like you're right at the end of it, it was something that came up in the final year audit and you've kind of been working on this a while, but how do we think about just where you are in the process on that?
Speaker Change: Trial.
Speaker Change: And we haven't made a decision on whether that would be something we would do alone. We think that would probably make sense to do with a partner.
Speaker Change: And so but we'd like to get the data first.
Speaker Change: Okay, and then thanks for that and then.
Speaker Change: Just on the 10-K delay so youre working through Jim with the noncash.
Speaker Change: Stock based comp and then some of the R&D.
Speaker Change: Where are you in that process. It sounds like you are right at the end of it. It was something that came up in the final year audit and you've you've kind of been working on this a while but how do we think about just where you are in the process on that and then.
James Young: And then, you know, in terms of, obviously you had disclosed it because of the delay, but in terms of materiality, you know, is this something that's, you know, less than 10% of your operating expenses or more than, I mean, what's the magnitude of kind of the changes we might expect to see for the year? Yeah, yeah. Those are perfectly fair questions, Bill. And as you can understand, being a former CFO yourself, I know I really can't get into details. Obviously, you know, the audit's being completed. It's a very detailed audit. You know, at this point, we're hoping the numbers don't change at all.
Speaker Change: In terms of obviously you have disclosed it because of the delay but in terms of materiality.
Speaker Change: Is this something thats less than 10% of your operating expenses or for more.
Speaker Change: What's the magnitude of kind of the changes we might expect to see for the year. Yes, yes. Those are perfectly fair questions Bill and as you can understand being a former CFO yourself.
Speaker Change: No I really can't get into details obviously.
Speaker Change: Audits being completed is a very detailed audit.
Speaker Change: At this point, we're hoping the numbers don't change at all if they do we will certainly inform the market and be very transparent about that but obviously I can't comment on what might change until the audit is complete. So we are we are very aware of the importance of this we are working very hard and we have new auditors. This year theyre doing a great job there.
James Young: If they do, we will certainly inform the market and be very transparent about that. But obviously, I can't comment on what might change until the audit is complete. So we are, you know, we are very aware of the importance of this. We are working very hard and, you know, we have new auditors this year. They're doing a great job. They're looking very closely at everything, which helps us and is great. So we're going to, you know, keep working to complete that. And once the results are done, we will, you know, if anything changes from what we published today, and I hope it doesn't, but if it does, we will be extremely transparent with the marketplace.
Speaker Change: We're looking very closely at everything which helps Allison is great. So we're going to keep working to complete that and once the results are done we will.
Speaker Change: If anything changes from what we published today and I hope it doesn't but if it does we will be extremely transparent with the marketplace and to comment on the magnitude of what it might be I really can't at this point I think you can probably understand.
James Young: And, you know, to comment on the magnitude of what it might be, I really Yeah. And then, you know, just to kind of circle back on one of the other questions asked, I mean, you've guided to 50% year over year growth. Yeah, we've seen a deceleration into the kind of the 40s for the past couple of quarters. Is it is it kind of that's what you expect? You know, is there some reason that it sounds like you're kind of back half loading the year for 25? Is this because all the you know, the accounts you brought on in the first three quarters, it takes them six or nine, 12 months to get going?
Speaker Change: Yes.
Speaker Change: And then.
Speaker Change: Just to kind of circle back on one of the other questions asked I mean, you have guided to 50% year over year growth.
Speaker Change: Yes, we've seen a deceleration into the kind of the the <unk> for the past couple of quarters.
Speaker Change: Is it is it kind of that switch you.
Speaker Change: Is there some reason that it sounds like you are kind of back half loading the year for 25 is this because all the accounts you brought on in the first three quarters. It takes them six or nine to 12 months to get going.
James Young: You know, I'm just trying to kind of understand, go back to that cadence question. Yeah. Mary, would you like me to take that one? Yeah, if you want, go ahead. Yeah, I think, Bill, you hit it kind of on the head. We have a lot of new accounts, as you've seen. And it takes a little while to drive the adoption and to drive more doctors within the institutions using the product. So yes, if I had to sit here right now, I would tell you it'll likely be a bit more backloaded. You've also got greater opportunities, obviously, with mapping and other things.
Speaker Change: Just trying to kind of understand go back to that cadence question Barry would you like me to take down.
Speaker Change: Yeah go ahead sure, yes, I think I think bill you hit it kind of on the head we have a lot of new accounts as <unk> seen and it takes a little while to drive the.
Speaker Change: To drive the adoption and to drive things drive more doctors within the institutions using the product so yes.
Speaker Change: If I had to sit here right now I would tell you that it will likely be a bit more back loaded you've also got greater opportunities with obviously with mapping and other things, but so so I wouldn't I would not be surprised to see that the 50% for the year being somewhat back end loaded a little bit, but we think we still have a great deal.
James Young: So I would not be surprised to see that the 50% for the year being somewhat back end loaded a little bit. But we think we still have a great deal of opportunity. We have very low market share. And we have a number of really positive catalysts coming, including the new accounts that you referenced.
Speaker Change: The opportunity we have very low market share and we have a number of really positive catalyst coming so including the new accounts that you referenced.
Unknown Executive: Great, thanks for taking my question. Thanks, Bill. Thank you, and I'm currently showing no further questions at this time.
Speaker Change: Great. Thanks for taking my questions.
Bill: Thanks Bill.
Bill: Thank you and I'm currently showing no further questions at this time I would like to turn the call back over to Mary Zillow for closing remarks.
Mary Szela: I'd like to turn the call back over to Mary Szela for closing remarks. Well, thank you, everybody. I really appreciate your time and insights and questions. Thank you. This concludes today's conference call. Thank you for your participation. You may now disconnect. A UPLIFTING SPRING BREAK
Mary Zillow: Well. Thank you everybody I really appreciate your time and insights and questions.
Bill: Thank you.
Bill: This concludes today's conference call. Thank you for your participation you may now disconnect.
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