Q1 2025 TriSalus Life Sciences Inc Earnings Call
Good morning, and welcome to Tri Salus Lifesciences first quarter 2025 earnings Conference call. Currently all participants are on listen only mode. We will be facilitating a question and answer session towards the end up todays call.
As a reminder, this call is being recorded for replay purposes.
I would now like to turn the call over to Alex Kurtzman Associate director with Life Science Advisors. Please go ahead.
Speaker Change: Thank you operator, and thank you all for participating in today's call joining me today from <unk>.
Speaker Change: Sciences, and Mary seller, President and Chief Executive Officer, James Young Chief Financial Officer, and Dr. Richard Marshall Medical Director.
Speaker Change: Michelle will provide an overview of the company's first quarter results and strategy for the balance of the year and then Jim will review the financial results for the quarter in detail.
Speaker Change: Marshall will join the call to help address questions from recovery.
Speaker Change: Earlier this morning, Tristylous released its financial results for the quarter ended March 31 2025.
Speaker Change: Copy of this press release is available on the trucks Alex website.
Speaker Change: Before we begin I would like to remind you that management will make statements. During this call that include forward looking statements within the meaning of federal Securities laws, which are made pursuant to the safe Harbor provisions of the private Securities Reform Act of 90 95.
Speaker Change: Any statements contained in this call other than statements of historical fact are forward looking statements.
Speaker Change: All forward looking statements, including without limitation statements relating to our sales and operating trends business and hiring prospects financial and revenue expectations and future product development and approvals are based upon our current estimates and various assumptions.
Speaker Change: 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.
Speaker Change: Yeah.
Speaker Change: 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 SEC and available on Edgar and in our other reports filed periodically with the SEC.
Speaker Change: <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.
Speaker Change: This conference call contains time sensitive information and is accurate only as of the live broadcast today may 15th 2025.
Mary: And with that I'll turn the call over to Mary.
Mary: Good morning, everyone and thank you for joining us today in the first quarter <unk> continued to make meaningful progress on its strategic priorities include growing market share for China or in the liver embolization market advancing our technology pipeline exploring new applications for pressure enabled drugs.
Mary: Livery or P E D D and preparing now have told him odd for a pharmaceutical partnership across multiple indications.
Mary: We achieved several key milestones in Q1 that lay the foundation for sustained momentum in 2025 and beyond we believe we're just beginning to realize the full potential of over a decade of hard work work that now positions us for multiple commercial and clinical catalysts in the coming year.
Mary: Importantly, with the completion of phase one trials for never told them hard we're shifting to a partnership focused strategy.
Mary: Transition allows us to eliminate all development expense and now we're told them out by the end of the year yet preserves the long term value of that program, while concentrating our internal resources on the immediate and broader opportunity within our P. E D D technology platform.
Mary: From a commercial perspective, we maintained strong momentum in the quarter, gaining further penetration in the complex liver embolization market.
Mary: While also expanding our technology into new clinical settings.
Mary: For our first quarter of 2025, we delivered $9 2 million in net sales of 42% increase compared to Q1, 2024, and 11% sequential gain over Q4 2024.
Mary: Our strategy remains grounded in five core areas number one driving adoption of P. E D D across a broad range of solid tumors.
Mary: Advancing new clinical applications for trying at improving manufacturing and gross margins expanding our product portfolio. Most recently with Tri net L D and try and try guide and continuing to build a high growth scalable organization.
Mary: Now, let me walk you through some of the key accomplishments from the quarter first.
Mary: First on market leadership and revenue growth our results for the quarter position us as one of the fastest growing med tech companies in the intervention oncology space.
Mary: Second we continue to generate compelling real world data at the society of Interventional oncology annual meeting, we presented updated health economic and outcome research and an analysis of over 600 P. E b treated patients compared to 16009 P E D.
Mary: <unk> patients we saw statistically significant reductions in 30 day inpatient admissions.
Mary: Improved fatigue outcomes and cost savings for providers. These findings are powerful they reinforced that interventional radiologists are choosing trying out for their sickest patients yet they're seeing tangible benefits.
Mary: Third we continue to grow our commercial footprint in Q1, we increased the number of unique ordering accounts by 39% versus Q1 2024, adding 32, new accounts in the quarter, while also seeing increased utilization per account.
Mary: <unk>, two both deepening engagement and expanding our reach.
Mary: Fourth we made a major step forward in reimbursement on April 1st the centers for Medicare and Medicaid services issued a hix picks code C 800 for providing coverage for mapping procedures using trying out. This means clinicians can now use <unk> for both treatment and planning and delivery and radio embolization.
Mary: And in fact this doubles the reimbursable use of our technology for Y 90 and supports broader adoption.
Mary: Fifth it S. I O. We also shared interim data from the tried by Y 90 study. This study address the poor correlation between M&A mapping and micro spirit delivery, which has been a long standing challenge and Y 90, or radio embolization therapy, the use of China for both phases showed improved.
Mary: Concordance, suggesting a more precise and reliable therapeutic approach. The study is closed and we are preparing the full dataset for publication.
Mary: Beyond liver cancer, we're also exploring new clinical applications for China in.
Mary: In Q1, we launched the protect registry a multicenter effort led by Sarasota Memorial and other clinical sites evaluating PD D. D for patients with direct nodules are going <unk>, who are not candidates for surgery radio iodine or ablation. The goal is to assess disease related koala.
Mary: <unk> of life thyroid function and other outcomes. Following P E D D based thyroid artery embolization.
Mary: This novel approach called P. E B Dash T. AE was pioneered by Dr. Juan Camacho and Dr. Camacho is now treated over 40 patients and has presented outcomes at NASA and S. A R and we're encouraged by the growing interest in this application.
Mary: In terms of product innovation, we launched trying to have large and try guide expanding ped into larger vessels. These additions support deeper penetration of the liver market and open up new procedural opportunities.
Mary: We're also pleased to note that following a successful market evaluation, we will soon be initiating the full launch of China of blocks <unk> four.
Mary: Emily known as trying to point out trying to flex demonstrated to deliver improved track ability and it is an important addition to our P. E D D portfolio, providing interventional radiologists with the device specifically designed.
Mary: To treat torturous vascular anatomy.
Mary: On the Nellix hold them out front, we successfully completed phase one trials.
Mary: In multiple liver tumor types, including metastatic uveal melanoma HCC in Cholangiocarcinoma. Additionally, we completed an enrollment imperial III our phase one study of <unk> in locally advanced pancreatic cancer, we expect final data in the second half of 2025.
Mary: As we wind down these trials, we're closing clinical sites and preparing final reports laying the groundwork for potential pharmaceutical partnership.
Mary: With this shift we also expect a significant reduction in R&D spend, particularly in the second half of the year and no further spend in 2026 now.
Mary: Now, let me touch on our financial position subsequent to the end of Q1, we raised approximately $22 million in gross proceeds through a private placement.
Mary: This additional capital strengthens our balance sheet and provides the resources needed to invest in further commercial resources pursue new clinical applications and expand our market opportunity.
Mary: Equally important we reached agreement with 55% of our preferred shareholders to implement an exchange offer converting preferred shares to common stock. This simplifies our capital structure removes the upcoming reset provision scheduled for July 2027, and better aligns our long term.
Mary: <unk> Investor base.
Mary: Looking ahead, we're entering the rest of 2025 with strong tailwind our strategic priorities are clear deepening penetration in the liver embolization market capitalizing on full reimbursement for both mapping and treatment advancing.
Mary: Trying to flex and trying to have large generating and publishing new <unk> clinical data and completing study reports and readouts for nella told them on to a lot of partnering discussions.
Mary: We believe China is on a clear path to becoming the standard of care for complex embolization.
Mary: Our focus is on strengthening the clinical evidence engaging key societies and building sustained commercial growth.
Mary: Wanted to confirm our guidance of at least 50% revenue growth to reflect our confidence in the momentum we're building.
Mary: While we remain committed to improving EBITDA performance.
Mary: We're also making a deliberate decision to invest in strategic areas of the business.
Mary: Specifically, we're allocating capital to accelerate development of new clinical applications of our core technology as well as expanding our commercial organization, which we believe will expand our addressable market and drive significant long term value as a result, we do not anticipate being EBIT positive or cash flow.
Mary: Positive in 2025.
Mary: In summary.
Mary: Our refined guidance reflects a company that is scaling investing in its future and focused on creating meaningful value for patients providers and shareholders alike. As always we remain a science driven organization committed to putting patients at the center of everything we do our progress is making a real difference for people.
Mary: Living with liver pancreatic and other solid tumors.
Mary: Finally, I want to thank our team their passion dedication and relentless focus on innovation are what makes this company special I'm grateful to all of our employees and shareholders for your continued support.
Speaker Change: We look forward to sharing more in the quarters ahead, and now I will turn it over to our CFO, Jim Young for the financial update.
Jim Young: Good morning, everyone and thank you Mary I am pleased to announce that <unk> achieved the following results in the first quarter that ended March 31, 2025, our revenue solely driven by the success of the <unk> device in the U S reached $9 $2 million. This sales achievement represents a 42%.
Jim Young: Increase compared to the same period in 2024 and is also up 11% sequentially compared to the fourth quarter.
Jim Young: <unk> has a track record of growth as illustrated on slide one which shows the company growing at a compound annualized growth rate of approximately 50% since the launch of our product in 2020.
Jim Young: These results can be attributed to several factors, including the adoption of trying to have a 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 to 10% of deliberate pace in care procedures.
Jim Young: Our gross margin profile of 84% in the first quarter of 2025 is slightly unfavorable compared to 85% in the first quarter of 2020 for this unfavorable margin profile in 2025 can be attributed to decreased factory volumes associated with the factory clean room expansion, which is.
Jim Young: Now been completed we believe our facility in Westminster, Colorado has the capacity to support our growth over the next five years with minimal capital investment.
Jim Young: In terms of our investments in research and development expenses for the first quarter of 2025 totaled $3 3 million a decrease of 44% from the first quarter of 2024 as.
Jim Young: As Mary noted earlier, we expect our clinical cost in 2025 to continue to decrease due to completion of Nellix toll about patient enrollment in all periods studies.
Jim Young: General and administrative expenses for the first quarter of 2025 totaled $5 million, representing an increase of over 7% compared to the fourth quarter of 2024, primarily due to the timing of audit and legal expenses are.
Jim Young: Our operating losses for the first quarter of 2025 totaled $7 3 million compared to losses of $11 7 million in the first quarter of 2024.
Jim Young: The decreased losses in 2025 can be primarily attributed to increased sales and reduced research and development expenses as noted earlier.
Jim Young: We have also published adjusted EBITDA results for the first time in our earnings release. We believe this is an important and useful measure of performance and we will continue and we will continue to publish going forward.
Jim Young: Our adjusted EBITDA losses for the first quarter of 2025 totaled $5 5 million compared to losses of $10 4 million in the first quarter of 2024 decreased losses in 2025 can be primarily attributed to increased sales reduced research and development expenses and higher noncash.
Jim Young: Stock compensation expense in 2025.
Jim Young: At quarter end, we have $13 million of cash and cash equivalents subsequent to the end of the first quarter, we raised $22 million in gross proceeds from our private placement. We believe these amounts provide us sufficient liquidity to fund operations throughout 2025, and as noted previously we expect to become cash.
Mary: Cash flow positive in early 2026, and now I will turn the call back to Mary for closing remarks.
Mary: Thank you Jim and thank you to everyone, who joined US on todays call at Tres Alex We're proud of the progress we made in the first quarter of 2025, we continue to advance the adoption of our <unk> technology across a growing number of clinical settings, and we've taken important steps to position now tomasz for potential partnerships.
Mary: That can unlock its full value.
Mary: These achievements are helping us to shape and exciting future for <unk> and we're energized by the momentum we're building with that I'll be happy to open the line for questions. We appreciate your interest and look forward to your insight. Thank you.
Mary: Thank you.
Speaker Change: As a reminder to ask a question. Please press star one on your telephone and wait for your name to be announced to withdraw. Your question. Please press star One again. The first question comes from Justin Walsh with Jones trading your line is open.
Justin Walsh: Hi, Thanks for taking the question I'm wondering what we should be looking for in the <unk> three read out I'm curious, what you think would be an attractive outcome to for potential partners.
Speaker Change: Sure.
Speaker Change: Let me remind you this was a phase one dose ranging trial and there are two components of it that we were studying number one this is a new technology that our novel technology. That's never been used before so this was our P. E. D. D device that access is the pancreatic tumor through the Venus SaaS.
Speaker Change: A chair, which no one has done and we we've concluded after 38 different infusions that we have a device that is highly highly functioning.
Speaker Change: Easy to use for the physician.
Speaker Change: And and performed very very well so that was number one we have a device that works very well with very minimal side effects number to what we're looking for in the data is this is a dose ranging study we collected quite a bit of correlated information, which is unusual for this type of a trial we had.
Speaker Change: Samples from tissue tumor tissue samples pre and post measured a lot of cytokines level premium.
Speaker Change: Pre and post and followed the patients for quite some time, we also had secondary endpoints of overall survival and all of their treatment I don't have the final data yet we have a couple of patients that were enrolled in the last few months of the year. So we will.
Speaker Change: Well review that data, we know that we have about 50% of the patients out of the 12 patients that were enrolled there were actually 13 patients one never received treatment, but on 12 patients about 50% of the patients are still alive, which is actually a good sign and one of the key things Theyre looking for is really Ken.
Speaker Change: That cannot drug melito Lamont stimulate the innate environment of the pancreatic tumor and that's what in conversations with various pharmaceutical partners. Just how profoundly does that does that occur and after two infusions and the overall safety profile. Those are the two areas of focus.
Speaker Change: For our pharma partners does that help.
Speaker Change: Yes, it doesn't maybe one very quick follow up.
Speaker Change: I'm just curious if youre seeing interest in Nellix Tal Ahmad.
Speaker Change: It's sort of in of itself or if its still is in conjunction with with the use of try NAV and just some thoughts if if you do find some partners here if your expectation that that your role would be assuming that they do trials that combined with trying to have essentially providing try now.
Speaker Change: And then.
Speaker Change: Possibly receiving royalties for melanoma, just curious how youre thinking about possible structuring and and so I'm sure a lot of that will be dependent on the partner of course right.
Speaker Change: So number one <unk> really can't be infused intramuscularly.
Speaker Change: This would actually create.
It can't be delivered IV arm that would create cytokine storm obviously it can be delivered via needle injection and what we saw that that was really suboptimal. So the way that we feel that really optimizes now let Tomas performance is through our technology and that's why how it would be developed and that's the data that they'll be looking at.
Speaker Change: The liver and in the pancreas.
Speaker Change: And the goal would be is that we would partner with them, we would handle obviously the whole procedural aspect.
Speaker Change: And hopefully potentially participate on the drug side, we think that P. E. D is really a platform for a whole range of different drugs to be delivered in this matter and this would be where we could deliver directly to the tumor site as well as this drug would be administered systemically and we think that could have a profound and.
Speaker Change: Packed in terms of outcome and that's what is really the interest of various pharma partners. How do you get a higher concentration in the tumor it doesn't take away from systemic delivery, which is addressing the micro metastases, but can you improve outcomes substantially by that combination.
Speaker Change: Great. Thanks for taking the questions.
Ross Osborne: And the next question comes from Ross Osborne with Cantor Fitzgerald. Your line is open.
Ross Osborne: Alright, thanks for taking our questions and congrats on the progress starting off would be curious to hear any feedback so far I'm trying to have large and what types of patients and clinicians are you seeing additional adoption with.
Speaker Change: Do you know what.
Speaker Change: But frankly, the largest performing really well I'll hand that call over to Dr. Marshall, who probably would even have a better insight into the larger vessel size patients, but where we hear the most of the adoption as is just larger tumors. We're also seeing it in uterine fibroid embolization, but Dr milestone you want to come.
Speaker Change: It further yes first of all good morning, and thanks for letting me all participate.
Speaker Change: I actually used to try to have large yesterday.
Speaker Change: And where we're seeing physicians use it most it's mostly in the liver.
Speaker Change: It's for tumors.
Speaker Change: That are fed by larger arteries. So.
Speaker Change: <unk> range or try to have large is.
Speaker Change: Artery, that's three to five millimeters in diameter.
Speaker Change: That's larger than a standard hepatic artery.
Speaker Change: So tumors.
Speaker Change: Tumors that are really vascular like hepatitis cellular carcinoma, neuroendocrine tumors and then multifocal.
Speaker Change: Are there multiple tumors and the same vascular bed.
Speaker Change: And we're seeing great results with it.
Speaker Change: <unk> are happy with it because.
Speaker Change: They're able to treat a larger area.
Speaker Change: And as Mary mentioned, we are seeing its use and uterine fibroid utilization gets larger capacity allows physicians to deliver more drug faster.
Speaker Change: And so those are the two primary uses.
Speaker Change: We are seeing increased use in the thyroid where some of those arteries are larger because it's larger quarters.
Speaker Change: And.
Speaker Change: I think that's a good synopsis of how it's being used now.
Speaker Change: Great I appreciate the color there and then.
Speaker Change: In terms of your clean room expansion when would those initiatives complete and how should we think about cadence for the balance of the year the gross margin line.
Ross Osborne: Yes, I can take that one Ross thank you.
Ross Osborne: It was completed in March so it was probably kind of February March timeframe, and obviously had a negative impact on gross margin. So now that it's completely done we're kind of back to full scale progress and I think our gross margins should definitely trend back up to kind of where they were previously so I would expect I would expect that.
Ross Osborne: Number to continue to improve.
Ross Osborne: For sure in the second quarter, and then depending on how good the second quarter is we still may get even better, but I would expect kind of.
Ross Osborne: Upper 80 percents.
Ross Osborne: We've hit 90 in the past that would be a great quarter, but upper 80 uses kind of ballpark, we should be playing in from a margin perspective.
Ross Osborne: Does that answer it Ross.
Ross Osborne: Perfect. Thanks for taking our questions and congrats on the progress.
Ross Osborne: Thank you thanks.
Speaker Change: The next question will come from Brian.
Ross Osborne: Inc.
Speaker Change: And then with Lake Street capital markets. Your line is now open.
Speaker Change: Great. Thanks for taking my questions. Congrats on all the progress I was hoping to start with cadence bank of revenue obviously in light of the financing you're increasing the sales force. So maybe how does that impact the growth rate as we go through the back half of the year to accelerate to achieve that 50% growth for the full year.
Speaker Change: Yes, so one of the things out of the whole private placement was really twofold. The goals are twofold number one we wanted we're seeing just incredible momentum we know that if we could add sales resources marketing resources, we could potentially even grow even even higher than our current growth rate and and so.
Speaker Change: We plan to add sales recent sources starting now we had we had a number of positions that we were targeting that we want to fill rapidly.
Speaker Change: We'll probably layer them in over the next couple of months and you'll see the biggest impact in the fourth quarter, but really the significant impact will be in 2026, usually it takes about three to six months for reps to really get their footing and get onboard and start driving meaningful volume.
Speaker Change: So you'll see that being peppered in over the second half of this year.
Speaker Change: Got it that's helpful. And then maybe just for the second one was hoping you could comment on maybe any feedback you've heard from physicians on the new mapping code I know when we spoke with physicians that was one of the key issues that they are speaking to of using the device more frequently in their practices. So maybe whats kind of early feedback.
Speaker Change: Understanding it's only about 45 days since that's been effective but what's early feedback and how should we kind of think about the impact of that.
Speaker Change: Really favorable I will tell you that.
Speaker Change: I think as a company I'm not sure we fully appreciated that that was holding us back, but we're really starting to see people use this much more predominantly and consistently.
Speaker Change: So very favorable feedback across the board.
Speaker Change: So we're very excited about it I think it now gives us.
Speaker Change: Full reimbursement and now with our product portfolio, we have a full vessel range size. So it allows physicians to adopt it much more broadly than how they were before I think it was more selective now that we have the full portfolio and a full reimbursement theyre very comfortable now using it in a much broader set of patients.
Speaker Change: And if I could add I think physicians, they're no longer worrying too much about.
Speaker Change: Can I use this in this setting it's much more straightforward.
Speaker Change: We're treating disease based upon their disease and not worrying so much about reimbursement.
Speaker Change: Got it that's helpful. Thanks.
Speaker Change: And our next question will come from Sue Rich Cala Ha with Oppenheimer. Your line is open.
Speaker Change: Hi, Mary can you hear me alright, yes, good good to hear your voice.
Speaker Change: Congrats on all the progress Hey, Mary on Palomar.
Speaker Change: I'm curious one of the drugs PK profile right.
Speaker Change: <unk> patients that you all have done.
Speaker Change: Would you characterize the relative balance between the drugs PK profile.
Speaker Change: Delivery mechanisms titration.
Speaker Change: Schedule across the patients do we know which side that is tilted more I guess, what I'm really trying to understand is.
Speaker Change: No.
Speaker Change: What leverage would you all have eventually.
Speaker Change: As you already started discussions with strategic partners.
Speaker Change: Yeah. So you know what's interesting we actually saw this end.
Speaker Change: Our our Uveal metastatic uveal melanoma trial that not all of them had had very long term effects.
Speaker Change: And then you actually saw late favorable effects, even eight months 10 months out. So we don't know exactly why that is the case, but we've seen that across the board.
Speaker Change: And we know that.
Speaker Change: <unk>.
Speaker Change: This drug and its effects and we're going to have some publications come out soon with hypotheses around the mechanism of action, but it's because it's the type C and its effect on myeloid derived suppressor cells. There is a hypothesis that it has a much longer duration of effect on the immune system.
Speaker Change: <unk>.
Speaker Change: I think thats just our early view of it. This is a phase one trial. So there is still so much to know about that.
Speaker Change: But I think what's what.
Speaker Change: The feedback that I've received from various people that I've spoken to and probably what I was intrigued other parties. The most was particularly in our Uveal melanoma.
Speaker Change: Static melanoma trial was that now it'll not actually helped patients who were checkpoint refractory. So obviously, that's a very big focus for big pharma on can you make a patient who is not receptive to a checkpoint receptor and so I think that was a big focus of their interest in <unk> does that help.
Speaker Change: Yes, yes fair enough.
Speaker Change: As a follow up 42% growth in trying out right, it's quite impressive, especially in the current environment I'm curious if you could give us some additional color.
Speaker Change: 42%, how broad base D J.
Speaker Change: Some additional.
Speaker Change: Granularity on utilization characteristics would be great. I know you had said 32, new accounts added, but just kind of give us a broader picture.
Speaker Change: To help us better understand the cadence as we walk through the quarter. Thanks again congrats.
Speaker Change: Typically we are first quarter is generally our lower first quarter, we usually come up a very strong fourth quarter, which we did.
Speaker Change: And then we see it build throughout the year I think one of the things that's been a catalyst for US is also getting.
Speaker Change: Additional code, which we had not planned for actually in our planning for 2025, we've really seen a nice improvement in momentum starting once the code was announced but what youll see is throughout the year, we start to see utilization.
Speaker Change: <unk> increased significantly and our and the part of that is due to the <unk>.
Speaker Change: Big focus change that we had from last year last year, we were just trying to get into new accounts. So we had a big focus about getting through vac approvals getting into as many different hospital accounts as possible. This year. We're in a very significant number of hospitals that are high volume our big focus is on driving utilization and generate.
Speaker Change: <unk> utilization beyond just one IR, but into multiple hires across consistent patient population. So we will start to see that utilization growth throughout the year and we actually built up our plan and are in a pretty ground up way, where we look at each every territory, where the physicians are using it.
Speaker Change: How that utilization is changing so we feel very comfortable about our guidance around the 50% growth hopefully that helps I don't know Jim If you wanted to add anything further I think that covers it I think the big focus last year like Mary said was getting a lot of new accounts through vac approval and now the focus is more geared towards utilization.
Speaker Change: So I think she's somewhat summed it up well.
Speaker Change: And I also think we have a lot better data that our physicians are using in particular health care economics outcomes research.
Speaker Change: Demonstrate cost savings with the use of trying out down.
Speaker Change: Down the road.
Speaker Change: I think people appreciate that.
Speaker Change: Devices actually useful from that from an economic standpoint.
Speaker Change: I appreciate it.
Speaker Change: The next question will come from William <unk> with Canaccord. Your line is open.
William: Great. Thanks good.
Speaker Change: Earnings.
Speaker Change: A couple of questions. If I could just first just on the kind of commercial organization on the sales force what was the number at the end of the quarter, where do you look to go by the end of the year as you're investing in this just trying to get some some data behind it and then.
Speaker Change: On the Newark on the accounts you had a big number of new accounts, but whats the net account number as you exited Q1.
Speaker Change: All up.
Speaker Change: Sure. So we currently have and we don't.
Speaker Change: Put out kind of we have clinical specialists and reps.
Speaker Change: And we have about 45.
Speaker Change: And then we have management our goal is over the next.
Speaker Change: 18 months I'd like to get to about between 60 and 70.
Bill: What we've been trying to do Bill and this is something that we've learned along the way.
Speaker Change: We hired probably too aggressively years ago, and we now really understand what the phenotype of the sales representative that we need and so we've been much more thoughtful about adding that type of wrap they have to have a blend of clinical skills technical skills, but they also need to know how to build a new therapy and we have a <unk>.
Speaker Change: Good array of different applications. So that's a more targeted type of representative that we're looking for so we will add that over the next 18 to 24 months that's our goal.
Speaker Change: And we've been very thoughtful about where to place them, where the volume is and how to balance that among the different applications and that's going to be a big part of it does.
Speaker Change: Does that help.
Jim Young: Yes, and then on the accounts Jim Yes.
Speaker Change: Yes, I think the accounts it was in the neighborhood of right around 300 at the end of the year and we added about 30 or 40. This quarter. So it's kind of been in the low to mid three hundreds.
Jim Young: Okay and then.
Jim Young: On the updated guidance and the push out of profitability just how much of that is a function of the.
Jim Young: Commercial organization expansion versus the <unk>.
Jim Young: Investment in thyroid and some of the other programs.
Jim Young: Yes, it's probably about 60% the expansion of the commercial organization and then about 40% investment in new applications, we're going to start a registry trial and two new applications. One is an genicular artery embolization, which we think is a really promising high growth area for us.
Jim Young: Also going to do a registry and uterine fibroid embolization and our goal is ultimately across a wide array of different application is built this registry data that allows us to refine what are the clear endpoints and differentiation of trying to have in these procedures.
Jim Young: Collect outcome data and collect data that ultimately we could submit for inclusion into the guidelines and so those registries are not as costly as cigna.
Jim Young: Significant clinical trial, but it can function like a clinical trial, because we can compared to standard of care. Although we can bill for therapy as those patients are enrolled and we'll have multiple different registries by the end of the year and then our goal in 2026 is to add some additional registries and some of the other air.
Jim Young: Or is the new applications that we're exploring right now.
Jim Young: Okay, and then less the last.
Jim Young: Question, if I can sneak one in just on the.
Jim Young: Second quarter.
Youre guiding 50% for the year the streets sitting at I think 10, four were 10, five so a little over $1 million.
Speaker Change: Is that something I mean, everything is back half loaded right now are you comfortable with the second quarter consensus at this point.
Jim Young: So we're taking my questions.
Speaker Change: Okay.
Speaker Change: And our next question will come from Jason Wittes with Ross. Your line is now open.
Speaker Change: Alright, thanks for the questions, mostly follow ups here.
Jason Wittes: First off on the Salesforce expansion does that get you to basically what you would consider a full penetration in terms of.
Speaker Change: Covering the entire country.
No not yet theres roughly about 400 hospitals.
Speaker Change: That represent about 80% of the procedural volume so I would say that over the next 18 months that will get us there.
Speaker Change: We fill all of those reps.
Speaker Change: But one of the other things that we're considering and we're working through right. Now is these new applications offer a whole lot of volume and so we're going back and looking at our procedural model and does these new applications and the utilization modified some of those plans. So I don't have a complete answer on that.
Speaker Change: With thyroid and Gi AE and some of these other new procedures, which are done in different locations that may modify that a little bit. So that's why I'm not answering that specifically, we'll have a better plan and understanding of that over the next couple of months.
Speaker Change: Okay, that's fair and did.
Speaker Change: Could you break out.
Speaker Change: Sure.
Speaker Change: To.
Speaker Change: Between tasting terror sort of what the trends have been in terms of usage right now.
Speaker Change: Maybe I'll have Dr. Marshall talk about that we see the data. It has generally been about 50 50, but we know that it's skewing a little bit more towards radio embolization. Dr. Marshall you want to talk about that yeah, I can talk about the overall feeling with our new CPT code for mapping.
Speaker Change: And I think that's really generating a lot of buzz among physicians.
Speaker Change: Thanks.
Speaker Change: As we look at the market as a whole terra is trending way higher than <unk>.
Speaker Change: The.
Speaker Change: Terra has become the number one.
Speaker Change: Local regional therapy to keep patients on liver transplant list.
Speaker Change: And so I think we will see that continue with the use of try now that will follow that path.
Speaker Change: And for <unk>.
Speaker Change: And we're still seeing very heavy use in things like neuroendocrine tumor embolization.
Speaker Change: And while that's a small subset of patients. These.
Speaker Change: These patients get numerous cannibalization, so one patient might receive four or six treatments over their lifespan.
Speaker Change: The growth is definitely inter.
Speaker Change: At the moment.
Speaker Change: Got it thank you I'll jump back in queue. Thanks very much.
Speaker Change: I am showing no further questions at this time I would now like to turn the call back over to Mary for closing remarks.
Speaker Change: Okay.
Speaker Change: Yeah.
Speaker Change: Oh, Okay. Thank you everyone I really appreciate you joining the call and thank you for all your questions.
Speaker Change: This concludes today's conference call. Thank you for participating you may now disconnect.
Speaker Change: Hum.
Speaker Change: [music].
Speaker Change: Yeah.
Speaker Change: Okay.