Penumbra - Earnings Call - Q2 2025
July 29, 2025
Executive Summary
- Q2 2025 delivered revenue of $339.5M (+13.4% YoY) and non-GAAP diluted EPS of $0.86; revenue and EPS both beat Wall Street consensus ($327.4M* revenue; $0.82* EPS), while gross margin was 66.0%, modestly below consensus (66.45%*). Values retrieved from S&P Global.
- Management raised full-year revenue guidance to $1.355B–$1.370B (from $1.340B–$1.360B in Q1), maintained U.S. thrombectomy growth of 20–21%, and reiterated full-year gross and operating margin targets.
- U.S. thrombectomy remained the growth engine: $188.5M (+22.6% YoY), with U.S. VTE up 42% YoY on strong adoption of FLASH 2.0 and Lightning Bolt 12; embolization/access rose to $109.2M (+13.9% YoY), aided by the Ruby XL launch.
- Margin trajectory remains intact despite front-loaded commercial hiring and XL launch costs; management reiterated the path to 70%+ gross margin by end of 2026 and expects sequential margin expansion in 2H25.
- Near-term catalysts: STORM-PE randomized trial results (fall), ongoing FDA process for Thunderbolt, and continued Ruby XL rollout; China headwinds showed signs of easing (small order placed after tariff pause).
What Went Well and What Went Wrong
What Went Well
- Non-GAAP EPS and revenue both exceeded Street expectations; operating income of $40.8M (12.0% margin) and adjusted EBITDA of $61.4M (18.1% margin) demonstrated disciplined execution. Consensus: $0.82* EPS; $327.4M* revenue. Values retrieved from S&P Global.
- U.S. thrombectomy revenue grew 22.6% YoY to $188.5M, with U.S. VTE +42% YoY; CEO: “We treated more VTE patients in the quarter than in any prior period”.
- Commercial and product progress: Ruby XL FDA-cleared and launched; over 50 embolization reps and 40 vascular clinical specialists added to sharpen focus across thrombectomy and embolization.
What Went Wrong
- Gross margin of 66.0% was slightly below consensus (66.45%*) and down sequentially versus Q1 (66.6%), reflecting XL launch investments and higher international mix; management expects sequential expansion in 2H25. Values retrieved from S&P Global.
- International thrombectomy declined 16.2% YoY, primarily due to continued China weakness; CFO noted headwinds should ease in 2H25.
- Street flagged margin pressure from front-loaded hiring and potential near-term mix variability; CFO confirmed no impact to gross margin from commercial hiring but acknowledged timing/mix effects and maintained full-year margin guidance.
Transcript
Operator (participant)
Ladies and gentlemen, good afternoon. My name is Abby, and I'll be your conference operator today. At this time, I would like to welcome everyone to Penumbra's Second quarter 2025 Conference Call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question-and-answer session. If you would like to ask a question during that time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, press star one a second time. Thank you. I would like to introduce Ms. Cecilia Furlong, Business Development and Investor Relations for Penumbra. Ms. Furlong, you may begin your conference.
Cecilia Furlong (Director of Business Development)
Thank you, Operator, and thank you all for joining us on today's call to discuss Penumbra's earnings release for the second quarter of 2025. A copy of the press release and financial tables, which includes a GAAP to non-GAAP reconciliation, can be viewed under the Investors tab on our company website at www.penumbrainc.com. During the course of this conference call, the company will make forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements regarding our financial performance, commercialization, clinical trials, regulatory status, quality, compliance, and business trends. Actual results could differ materially from those stated or implied by our forward-looking statements due to certain risks and uncertainties, including those referenced in our 10-K for the year ended December 31, 2024, filed with the SEC.
As a result, we caution you against placing undue reliance on these forward-looking statements, and we encourage you to review our periodic filings with the SEC, including the 10-K previously mentioned, for a more complete discussion of these factors and other risks that may affect our future results or the market price of our stock. Penumbra disclaims any duty to update or revise our forward-looking statements as a result of new information, future events, developments, or otherwise. On this call, financial results for revenue and gross margin are presented on a GAAP basis, while operating expenses, operating income, and adjusted EBITDA are presented on a non-GAAP basis. The corresponding GAAP measures and a reconciliation of GAAP to non-GAAP financial measures are provided in our posted press release.
Non-GAAP operating expenses and operating income exclude amortization of acquired intangible assets of $2.4 million and impairment of our immersive healthcare business of $76.9 million in the second quarter of 2024, and adjusted EBITDA excludes impairment expenses, stock compensation expense, depreciation and amortization, provision for income taxes, and interest income expenses. Adam Elsesser, Penumbra's Chairman and CEO, will provide a business update. Maggie Yuen, our Chief Financial Officer, will then discuss our financial results for the second quarter of 2025, and Jason Mills, our Executive Vice President of Strategy, will discuss our updated 2025 guidance. With that, I would like to turn over the call to Adam Elsesser.
Adam Elsesser (Chairman and CEO)
Thank you, Cecilia. Good afternoon. Thank you for joining Penumbra's second quarter 2025 conference call. In the second quarter, we generated total revenue of $339.5 million, representing underlying year-over-year growth of 13.4% on a reported basis and 12.7% on a constant currency basis. Our second quarter performance reflected extraordinary ongoing execution by our commercial team against our strategy, together with our focus on continuous innovation, clinical and health economic data generation, together with the work physicians are doing to further expand the total number of patients treated globally with our novel technologies. Our U.S. thrombectomy business led overall growth in the quarter, with results reflecting strong continued adoption and ramping utilization of our CAVT portfolio, while our U.S. embolization and access business, as well as our international business, delivered solid growth ahead of expectations. Second quarter U.S.
thrombectomy revenue increased 22.6% year-over-year to $188.5 million, led by 42% year-over-year growth in our U.S. VTE franchise, as the clinical benefits of FLASH 2.0 and Bolt 12 continue to support and drive further market penetration and competitive conversions. Below the top line, gross margin of 66% was in line with our prior announced expectation as we executed on our planned accelerated Ruby XL inventory build. We began shipments of XL at the end of the second quarter and entered the third quarter well-positioned from an inventory standpoint to meet the strong interest in XL we've seen in the field to date. We remain on track and are well-positioned to achieve a gross margin profile of over 70% by the end of 2026 and expect operating margin expansion to outpace gross margin expansion for the foreseeable future as we prioritize delivering profitable growth and an expanding profitability profile.
Turning to our U.S. peripheral business, our second quarter thrombectomy performance reflected the competitive strength and clinical benefits of our comprehensive current CAVT portfolio, spanning FLASH 2.0, Bolt 6X, Bolt 7, and Bolt 12, alongside purposeful and focused execution by our commercial team. We treated more VTE patients in the quarter than in any prior period, supported by our team's relentless focus and prioritization on improving patient outcomes, driving conversions from anticoagulation, lytics, and other mechanical thrombectomy platforms to CAVT in both PE and DVT. In arterial, the clinical benefits of our modulated aspiration technology in Bolt 7 and Bolt 6X continue to support and drive physician conversions from open surgery or the use of lytics to CAVT.
Based on our consistent success and our clear view of the opportunity ahead in peripheral thrombectomy, we strategically invested in the build-out of a separate peripheral embolization sales force so as to provide heightened focus in thrombectomy and embolization. We have added over 50 embolization sales reps and over 40 vascular clinical specialists. With these new hires in place, we will be able to have a team solely focused on our thrombectomy business, as well as a separate team focused on launching Ruby XL and driving long-term growth in our embolization business. Adding to the information we provided on our last earnings call, Ruby XL is a larger, softer, and longer coil than other commercially available coils and allows us to now participate quite effectively in about 20% of the current market that we have not been able to in the past.
With the early performance of Ruby XL, we expect to see ramping benefit from our investment in our commercial team through the back half of the year and beyond, with our thrombectomy team well-positioned to exclusively focus on continuing to address the significant unmet need in the treatment of clot burden throughout the body and our new EMBO team able to focus on providing our comprehensive coil portfolio to physicians and hospitals. As our team drives adoption of our technology on a day-to-day and account-by-account basis, we are simultaneously focused on positioning CAVT for long-term growth while enhancing our competitive position. Advancing the field through technology innovation and high-quality clinical data generation is our priority. During the quarter, we completed enrollment in STORM-PE, our prospective multi-center randomized controlled trial evaluating CAVT plus anticoagulation versus anticoagulation alone for the treatment of acute intermediate high-risk PE.
We are committed to running trials which hold the potential to fundamentally shift patient treatment, and STORM-PE has the potential to provide level one evidence to help inform PE treatment and impact standard of care. Enrollment in STORM-PE completed ahead of schedule, and we look forward to presenting the results from the trial at a major medical conference this fall. On the arterial side, we recently announced the launch of our STRIDE II clinical study. Our initial STRIDE study, which incorporated primarily older generation technology, demonstrated compelling results, including a 98.2% 30-day limb salvage rate. With STRIDE II, we intend to both expand the patient sample size and broaden the geographic enrollment base in comparison to STRIDE, with STRIDE II focused on demonstrating the benefits of our latest generation CAVT technology.
Looking forward, we will continue to invest in high-quality clinical studies in tandem with our market access initiatives to highlight the significant benefits and value proposition of our differentiated current and forthcoming products. Shifting to our neurovascular business, excuse me, our U.S. stroke thrombectomy franchise delivered another solid performance, growing ahead of the underlying stroke market. In its first full quarter on the market, Red 72 Silver Label, with its enhanced trackability, continued to generate strong physician interest and saw ramping adoption and utilization. Regarding Thunderbolt, we are currently in an active process with the FDA and will provide additional updates as soon as possible. We remain very excited to introduce Thunderbolt to the neurovascular field. At SNIS earlier this month, there was a great deal of discussion about distal occlusions in stroke.
We heard many physicians confirm that our RED 43 aspiration catheter is the preferred device to treat patients with distal occlusions. Finally, there was a lot of discussion among physicians about embolizing the middle meningeal artery, or MMA as it is commonly known, and the unique properties of our Swift coil that allows for the safest treatment modality. It is estimated that there are more patients that could be treated in this category than traditional cerebral aneurysms. We are focused on investing in further innovation across our diversified neuro portfolio, spanning aspiration, access, and embolization. In summary, our second quarter results reflect solid execution by our team as we continue to deliver long-term growth in multiple under-penetrated markets. We are committed to continuing to transform patient care across these markets and are excited to introduce new innovative products in the months and years ahead.
I'll now turn the call over to Maggie to cover our financial results for the second quarter of 2025.
Maggie Yuen (CFO)
Thank you, Adam. Good afternoon, everyone. Today, I will discuss the financial results for the second quarter of 2025. Financial results on this call for revenue and gross margin are on a GAAP basis while operating expenses, operating income, and adjusted EBITDA are on a non-GAAP basis. The corresponding GAAP measures and our reconciliation of GAAP to non-GAAP financial measures are provided in our posted press release. For the second quarter ended June 30, 2025, our total revenues were $339.5 million, an increase of 13.4% reported and 12.7% in constant currency compared to the second quarter of 2024. Our geographic mix of sales for the second quarter of 2025 was 76.8% U.S. and 23.2% international. Our U.S. region reported growth of 19.5%, driven by 22.6% growth in our thrombectomy franchise compared to the same period last year.
As we anticipated, our international regions decreased 3.2% reported and 5.8% in constant currency, primarily due to a decrease in China revenue compared to the same period last year, which was partially offset by an increase in all other international regions. As we look ahead for the second half of 2025, we expect headwinds in China to ease, resulting in a return to growth across all of our international regions. The sequential growth in our total revenue of 4.7% was driven by both an increase in global thrombectomy and embolization and access revenue across all regions compared to the first quarter of 2025. Moving to revenue by products, revenue from our global thrombectomy business grew to $230.3 million in the second quarter of 2025, an increase of 13.1% reported and 12.6% in constant currency compared to the same period last year, which was primarily driven by growth in our U.S.
thrombectomy business of 22.6%. Our international thrombectomy business decreased by 16.2%, in line with expectations, primarily due to a decline in China revenue. Excluding the impact to the China region, our international thrombectomy revenue grew by 14.4% when compared to the same period last year. Revenue from our embolization and access business was $109.2 million in the second quarter of 2025, an increase of 13.9% reported and 12.8% in constant currency, primarily driven by an increase in U.S. embolization sales, underscoring the launch of our new XL product. Gross margin for the second quarter of 2025 is 66% compared to 54.4% for the second quarter of 2024, which includes a one-time $33.4 million immersive healthcare inventory write-off. Excluding this one-time write-off, the gross margin slightly increased year over year.
As expected, our gross margin slightly decreased sequentially due to investment in the launch of our XL product and the high international mix of growth across all regions. As we move to the second half of 2025, we expect to see sequential margin expansion from favorable product mix and productivity improvements. In addition, we are on track to achieve our full-year gross margin targets. However, as our separate thrombectomy and EMBO teams start ramping, we might see some month-to-month variability in product mix. Importantly, we remain well-positioned to deliver our long-term gross margin profile of 70% by the end of 2026. Now onto our non-GAAP operating expenses, non-GAAP operating income and margin, and adjusted EBITDA. Total operating expense for the quarter was $183.2 million, or 54% of revenue, compared to $164.5 million, or 54.9% of revenue for the same quarter last year.
Our research and development expenses for Q2 2025 were $23.2 million, or 6.8% of revenue, compared to $24.9 million, or 8.3% of revenue for Q2 2024, which reflects savings of $5.2 million due to our immersive business wind-down, offset by continued investment in product development. SG&A expenses for Q2 2025 were $160 million, or 47.2% of our revenue for Q2 2025, compared to $139.6 million, or 46.6% of revenue for Q2 2024. To support the momentum in demand and ensure we are positioned to capitalize on long-term growth drivers, we made targeted hires in our commercial and market access teams. Sequentially, our expense increased by $6.5 million, which, as Adam mentioned, was primarily due to a deliberate front-loaded investment in our embolization sales team and additional vascular clinical specialists.
With a favorable hiring market to attract top-tier talent, we acted to bring in a high-impact commercial team, which we expect will contribute to our results in the quarters ahead. We recorded operating income of $40.8 million, or 12% of revenue, compared to an operating loss of $1.6 million for the same period last year, which includes a one-time $33.4 million immersive healthcare inventory write-off. Excluding this one-time write-off, our operating profit increased by $9.1 million. We posted adjusted EBITDA of $61.4 million, or 18.1% of total revenue, compared to $13 million, or 4.3% in the second quarter last year. Turning to cash flow and balance sheet, we ended the second quarter of 2025 with cash, cash equivalents, and marketable securities balance of $424.6 million and no debt, which is an increase of $45.7 million sequentially, driven by strong operating profitability.
We expect positive operating cash flow trends to continue in 2025 and beyond. Now I'd like to turn the call over to Jason to discuss our updated 2025 guidance.
Jason Mills (EVP of Strategy)
Thank you, Maggie, and good afternoon, everyone. Due to our performance in the second quarter, we are increasing our guidance for total revenue to a range of $1,355 million-$1,370 million, which represents 13%-15% year-over-year growth. We maintain our guidance for U.S. thrombectomy growth of 20%-21% compared to 2024 levels. We also maintain our guidance for both gross margin and operating margin for full year 2025. This concludes our prepared remarks. Operator, we can now open the call to questions.
Operator (participant)
Thank you. At this time, I would like to remind everyone, in order to ask a question, press star and then the number one on your telephone keypad. We will pause for just a moment to compile the Q&A roster. Our first question comes from the line of Larry Beagleson with Wells Fargo. Your line is open.
Lawrence Biegelsen (Senior Medical Device Equity Research Analyst)
Good afternoon. Thanks for taking the question and congrats on a nice quarter here. Adam, I wanted to start with STORM-PE and then ask a Thunderbolt question. It is good that we are going to see the STORM-PE data this fall. Adam, it is a relatively small study, and we have seen many PE trials with RV/LV ratio as the primary endpoint. Why is this study important? And what impact could it have if positive? I had one follow-up.
Adam Elsesser (Chairman and CEO)
Yeah, no, it's a great question. As you know, Larry, it's the first randomized study completed that we're aware of in the world comparing anticoagulation and mechanical thrombectomy to anticoagulation alone. We've seen lots of single-arm studies and other things. It's the first randomized study that has that comparison, which is the question that everyone wants answered. For that reason alone, it's significant. The size of the study is a testament to the confidence in the product. Obviously, the larger the study, the more room you have to have a difference. You have 100 patients, it's a lot smaller number of patients to show that difference. It actually is a testament to, I think, the confidence in the study. That being said, I think you're aware, we put together an international, very renowned group of physicians on the steering committee of this trial.
They were the ones who came up with the endpoints and the size of the study and the powering of it all. Really, these are just not interventionalists. These are non-interventionalists in the field of treating PE. I think it's, again, we'll wait to see the results, but I think it could have a significant impact. Again, the design of the study is a testament to the work of some of the world's experts.
Lawrence Biegelsen (Senior Medical Device Equity Research Analyst)
That's helpful. Then on Thunderbolt, Adam, any update on how we should think about the FDA review time? I think in the past, if I'm not mistaken, you've pointed to precedents that had about a six-month review time. Lastly, some investors, Adam, I think, have construed some of your recent comments that your enthusiasm for Thunder has changed. Could you address those items, please? Thanks.
Adam Elsesser (Chairman and CEO)
Sure. Yeah, I do not remember saying six months for a clinical study. The product review times vary depending on the company. That being said, I can tell you the following. We have worked with the FDA for many, many years, the neuro division. I can tell you that they are thorough, which is something that I am extremely supportive of. These are obviously products going up into people's brains, and I am very supportive of that process. The process is what we expected with the FDA. To be honest, I have heard the rumors that I am somehow not excited. I do not know how to say it any more than I have said it over and over. It is an amazing product, and I think it will have a huge, huge positive impact for many, many people for many, many years to come.
Lawrence Biegelsen (Senior Medical Device Equity Research Analyst)
All right. Thanks so much.
Adam Elsesser (Chairman and CEO)
Thank you.
Operator (participant)
Our next question comes from the line of Travis Steed with Bank of America. Your line is open.
Travis Steed (Managing Director of Equity Research and Medical Technoloy)
Hey, thanks for taking the question. I guess the first question I'd ask about the sales force split, why now is the right time and how you're thinking about the kind of any near-term disruption from that and kind of the margin question. I know there was a comment kind of made on the mix on margins.
Adam Elsesser (Chairman and CEO)
Yeah, so the margin, the comment I made about margins in my talk was we had said on the last quarter that we were accelerating the build of Ruby XL, so there'd be a one-time, one-quarter impact to do that, which we saw a minor impact. That doesn't go beyond this quarter. I think we reiterated very clearly that we are on track for our 7 plus percent at the end of 2026. That being said, it is worth noting that the Ruby XL is, their margin, given the nature of that coil the price point, is actually accretive to our margin. That's a positive for us. Why now for the split here?
It is essential given the success that we're having in the thrombectomy side on that business, and our view of where that continued growth will come, it's a pretty extraordinary opportunity that we really need to have people be able to focus. They can't. They're selling right now on the thrombectomy side alone into the arterial, DVT, PE, coronary. Then to add a whole bunch of different types of embolization procedures was a lot for our reps to do, and to do it well across all of their customers. This just makes sense to do it by focus. I think we have been lucky to be able to attract literally some of the best talent there is in the field.
I think it will prove to be great for our thrombectomy business because that focus, and to be honest, it will allow our peripheral coil business, our embolization business, to continue to be successful and probably accelerate growth given the launch of the product and the focus that that team has. It makes sense all around.
Travis Steed (Managing Director of Equity Research and Medical Technoloy)
Thank you. Then kind of the second question is on the U.S. thrombectomy business, the 20%-21% guide. It kind of did 24% in the first half, kind of implies 18% in the second half. I know the stroke market slowed a bit. I do not know if that is kind of the main reason there, if there is any kind of thing else you would call out for the second half of the U.S. thrombectomy business.
Adam Elsesser (Chairman and CEO)
Yeah, no, I think it's fairly obvious that we're pretty excited about our thrombectomy business going forward. Obviously, we raised our overall guide the quarter before, we raised our U.S. thrombectomy guide. I think we're, just to be honest, trying not to get ahead of ourselves in spite of our enthusiasm right now.
Travis Steed (Managing Director of Equity Research and Medical Technoloy)
All right, great. Thank you. Congrats on the good quarter.
Adam Elsesser (Chairman and CEO)
Thank you.
Operator (participant)
Our next question comes from the line of Robbie Marcus with JP Morgan. Your line is open.
Robbie Marcus (Senior Analyst)
Oh, great. Thanks for taking the questions. Wanted to ask on margins and if there's any way you could quantify the impact of the additional sales force build-up here. Gross and operating margins came in below the street. Just trying to figure out if it's that or if it's maybe tied to the outside U.S. and other outperformance. Maybe there was some stocking there or something like that. Thanks.
Adam Elsesser (Chairman and CEO)
Sure, Maggie.
Maggie Yuen (CFO)
Yeah, no, thanks. I can take on the margin impact first. In terms of our investment in our commercial team, it has no impact to our gross margin. I think the comment that I make about the mix as a result of the commercial team investment is because, as I mentioned, both of our thrombectomy and the new XL product are accretive, and they both lead to supporting eventually our 70% margin profile. In terms of the timing of the margin mix, it just could be varied from month to month, quarter to quarter. Nevertheless, we still continue to see expansion in Q3 and in Q4 at the same time. In terms of operating margin, I think investing in our commercial team has been in our strategic investment for the year. It's just for the right timing and right opportunity, we accelerate some of the investment in Q2.
At the same time, overall, we are still maintaining our full-year margin guidance, so no material impact to the outquarters.
Adam Elsesser (Chairman and CEO)
Thank you.
Robbie Marcus (Senior Analyst)
Great. Maybe a quick follow-up. Adam, now that we do not really have a lot of detailed reporting now that your competitor has been acquired. As I am thinking about U.S. thrombectomy, I was wondering if you could just give us a quick state of the union of what you think sort of the end market growth rates are in stroke and the different areas in peripheral. Because I am looking at U.S. thrombectomy, reiterating the guide implies a deceleration in the back half of the year. I am just trying to figure out what is your weighted average end market growth in U.S. thrombectomy relative to the number growth rate implied. Thanks a lot.
Adam Elsesser (Chairman and CEO)
Yeah, it's a fair question. It's, as you know, hard to get accurate market information, particularly when we're the only ones sort of talking about our numbers. You can't really triangulate them with other people's real numbers. You're getting these sort of partial data sets and trying to triangulate it. I don't want to over-rely on those kind of sources because they've proven not always to be accurate, as everyone knows. I'll share sort of as best I can sort of how we're going. Obviously, our VTE growth is leading the way. Third quarter in a row of over 40%. Obviously, the market isn't growing at 40%. It's growing somewhere around 20%, give or take, is our best guess. Again, we're continuing to take share there. The arterial business, again, it's less about a market growth there because you're really treating all those patients, but mostly with open surgery analytic.
It's moving those patients from one modality to us. That had another very strong quarter. We grew similar to what we've done in the past couple of quarters. The market growth in neuro, I'll be honest, was a little soft, but we continue to grow well above that number as best we can tell. Because of the setup with Red 72 Silver Label, the silver label version. Frankly, it puts us in a really, really good position. I've always said that we want to try to move physicians to that product in anticipation of the Thunderbolt launch. I think it's given us that opportunity to really do that. Growing above the market shows that the share is shifting and the setup for Thunderbolt is great. Obviously, you know our coronary business, it's a much more mature business. It's obviously not growing at those same levels.
Robbie Marcus (Senior Analyst)
Very helpful. Appreciate it, Adam.
Adam Elsesser (Chairman and CEO)
Yeah, of course.
Operator (participant)
Our next question comes from the line of Richard Newitter with Truist. Your line is open.
Richard Newitter (Managing Director)
Hi, great. Thanks for taking the questions. Congrats on the quarter. I wanted to go back to kind of some of the sales force initiatives you have going on here. Adam, you had, in late 2023, I believe, you identified the need for an expanded sales organization. With so many different call points kind of coming in, and that was kind of more feet on the street. Here, you're taking a little bit of a different approach, splitting the sales organization. You gave the rationale in an answer to a prior question. I'm just curious, how do we think about the impact on the business and the time that will take to get the return on that investment or the payoff before 1 plus 1 equals 2? If you can compare and contrast kind of this initiative versus the prior one.
Adam Elsesser (Chairman and CEO)
Yeah, it's a fair question. The good news is we aren't starting the process of hiring those people. We've already hired them all. The vast majority of them have fully been trained and in the last month or so have been sort of operational, if you will, in the field. We already kind of are past that process of sort of going through that. I have a lot of confidence that as we look at the back half, those teams will be operating exactly how they should be focusing on what they should be focusing on. Obviously, we're still one team overall, and they're sharing managers. There's going to be some capacity to help each other out and do all that, which I think is really important for the long-term success. Their incentives are aligned to focus on the parts of their business that they're assigned to.
I think we're going to be in really good shape. I think a lot of the heavy work is done and has been in moving in that position for the last number of months. I think we're in pretty good shape. It's a great idea. I mean, the team came up with it. I'm thrilled. Their execution on it has been really extraordinary. You always have a little bit of stuff going on, but I think all of that is very minor and is behind us.
Richard Newitter (Managing Director)
Got it. Just maybe a follow-up. I appreciate you don't want to get ahead of yourself. The first half is clearly coming in a little bit better than expected. On U.S. venous. And then also on embolization. The implied deceleration that's in your guide, maybe that reflects some conservatism, but assuming all trends were to hold, more or less, is there any one division that you anticipate a slowdown or you're seeing something in the underlying market? I'm just trying to get a sense for within our U.S. arterial or U.S. neuro thrombectomy or even coronary. Is there any anticipated slowdown or trend that's beginning to emerge that you're seeing?
Adam Elsesser (Chairman and CEO)
No, I think I sort of laid out. The two areas that have a little bit softer growth, if you will. Obviously, stroke as a market, I think if you look at all the data that people can buy out there, it shows that it really did not grow a lot in the last months or so. We continue to take share. I think that is great for us. I think that will continue, particularly as the market digests sort of what the right size product is and how that all works. Sort of that setup and sort of getting ready for Thunderbolt continues. I think that puts us in an okay shape. Predicting the time of all that, you have got to give us a little leeway. We do not control that, and we need to sort of be a part of that.
Again, the coronary business is a great business. We treat a lot of patients, but it is a much more mature business with sort of analog technology, which is great in coronary, but that is obviously not growing at that level. There is nothing other than that and us just being. Obviously, we still have fresh memories of having our enthusiasm get the better of us, and we are going to try not to do that.
Richard Newitter (Managing Director)
Yep. No, I'm not criticizing. That's the right thing to do. Okay.
Adam Elsesser (Chairman and CEO)
Okay. Thank you.
Thank you.
Operator (participant)
Our next question comes from the line of Bill Plovonik with Canaccord. Your line is open.
Bill Plovanic (Managing Director of Equity Research Medical Technology Analyst)
Great. Thanks. Thanks for taking my questions. Just first off. It looks like it was really the international and the embo access that kind of drove some upside in the quarter, kind of. Versus at least our expectations and I think consensus. I'm just wondering if there's any sea change you saw there or are some of these markets coming back sooner than you expected? Maybe even specifically on China, I think there was some commentary there. I know you had zero in expectations for this year. Is that how that's coming in, or is that starting to come back on board? I have one follow-up. Yeah. Look, I think we have, as you know, we had some headwinds internationally for a number of reasons over the last year or so. Obviously, the scale of the pullback on our China business has been a headwind for a couple of years.
Adam Elsesser (Chairman and CEO)
We got out of some markets because of gross margin issues. That was a headwind for a while. We've been really working pretty diligently for a while to sort of make sure our international business is set up for success. Obviously, in certain markets, our CAVT products like FLASH 2.0 and the Bolt products are in those markets now and starting to launch. We're starting to see the benefits of all that work. That's really what you're seeing right now. It's great to see it come together. Again, what ultimately will continue to drive it is the U.S.
thrombectomy business, but now a little bit with some of the embolization business because I think we've got a good run ahead with that Ruby XL product, which is, I'll be honest with you, some of the great compliments are coming from physicians who are using that and really seeing just extraordinary things that they can do for their patients. It's very gratifying. I think we're set up.
Bill Plovanic (Managing Director of Equity Research Medical Technology Analyst)
China contribution in the quarter, Maggie?
Adam Elsesser (Chairman and CEO)
Oh, I'm sorry, you did ask that question. I apologize. I didn't write that question down. When there was a lifting of the or pausing of the tariffs or whatever we call it, China did ask for a small order. It was not particularly material, but we did fill it.
Bill Plovanic (Managing Director of Equity Research Medical Technology Analyst)
Okay. Thanks. On my follow-up, just, I understand and appreciate kind of the process with the FDA on Thunderbolt. I'm just, you've submitted your, you ran your trial, you've submitted your filing, you're going through the process. I think your commentary was nothing surprising. At this point, you should be getting towards the end of that. Is there any more data or studies or anything else you need to provide, or is this just answering basic questions and labeling as we think about the process to get the product cleared from the FDA and on the market?
Adam Elsesser (Chairman and CEO)
I 100% appreciate and respect the question. I think there's only—I'm only going to get in trouble if I answer that because it's going to be a nuanced thing that it's going to be misunderstood. I don't want that to be done. Let me stick with what I said, which is we're going through the process. It's what we expected, and we can't wait to launch this product.
Bill Plovanic (Managing Director of Equity Research Medical Technology Analyst)
All right. Great. Thanks, Adam. Thanks.
Adam Elsesser (Chairman and CEO)
All right. Thank you.
Operator (participant)
Our next question comes from the line of Brandon Vazquez with William Blair. Your line is open.
Brandon Vazquez (Research Analyst)
Hey, everyone. Thanks for taking the question and congrats on the quarter. Adam, coming out of SNIS, I think there was a little discussion about potentially being able to reinvigorate some of these efforts or kind of like refocus the neuro community onto getting these patients into the stroke centers and prioritizing thrombectomy. Appreciate we might be early in that, but as we're moving past COVID and this might become a little bit more of a focus now in the stroke markets, maybe the growth has been a little bit dampened. How do you think about what Penumbra can do? How do you think about what the industry is doing? Is there a point in the near future where we can start to re-accelerate the growth of the stroke market?
Adam Elsesser (Chairman and CEO)
Yeah, Brandon, I think it's a really important question and one that I actually think a lot about since we've been here for many, many years. Trying to make sure that that happens. There is no question there are some, and frankly, a decent number of some just extraordinary centers, hospitals, physicians, leaders who are doing that work in their communities to make sure that everyone that can be treated, should be treated, is getting treated. That is the most heartening thing when we see that. Unfortunately, it's not at every town, at every community, at every hospital. I don't know how fast the centers that aren't doing that will sort of get on board. I can't predict that. It is still happening, and it's exciting to see that.
I think, like anything, that has been sort of the big challenge with the neuro business, the stroke business, is making sure that people get to the right place to be treated. That's obviously one of the reasons we're seeing such higher growth on the vascular side because they don't have that issue. They go to a hospital, and they can be treated in almost every place they go. I'm optimistic. I do think that Thunderbolt helps that. I do think it allows for a much faster, easier procedure, hopefully, that allows people to sort of, in effect, democratize it and feel like they can treat more of those patients. Let's wait and see. I don't want to get ahead of ourselves. We'll wait till that's approved, and we'll see what happens. I'm optimistic.
Brandon Vazquez (Research Analyst)
Okay. And then maybe as a follow-up on the mbo side of the business, now that you're building out a Salesforce, there's some new products like Ruby XL and maybe SwiftPAC and the MMA embolization. I'm kind of curious if you would categorize this as maybe a little bit of a turning point for EMBO. In the sense of, can this be kind of a materially even better part of the business once this separate kind of Salesforce builds out? It seems like you're viewing a big opportunity there. Please rein me in if I'm getting ahead of my own skis here. Clearly, you're seeing something. Is this something in a year from now we're going to be looking back and saying, "This is why Penumbra invested so much into this segment"? Thanks.
Adam Elsesser (Chairman and CEO)
Yes. That's what I hope.
Operator (participant)
Our next question comes from the line of Ryan Zimmerman with BTIG. Your line is open.
Ryan Zimmerman (Managing Director and Medical Technology Analyst)
Thank you. Can you hear me okay?
Adam Elsesser (Chairman and CEO)
Yes.
Ryan Zimmerman (Managing Director and Medical Technology Analyst)
Thank you. All right. Congrats on the quarter. Not to stir the pot here, Adam, I just want to understand. Can you just confirm that could we see clearance of Thunderbolt ahead of a possible data presentation at SVIN in November? Is that within the realm of possibilities?
Adam Elsesser (Chairman and CEO)
Yeah. Again, I totally appreciate the question. I do not think you are stirring the pot at all. I do not mean to answer the question the way I have answered the last two or three times, but we are in an active process. Obviously, I do not control it. We are going through that process, and it is what we expected. As soon as we can, we will tell you something. I cannot say more than that. I think it is pretty obvious. I have a lot of respect for the various attempts to get me to say something else.
Ryan Zimmerman (Managing Director and Medical Technology Analyst)
That's fine. I'll stick just two more around neurovascular. One, I was also at SNIS. We saw the distal trials early in February at ISC. Do you think you need to do a distal aspiration trial? Because clearly, all three of those trials were with stent retrievers. We saw a subgroup analysis on aspiration and M2, and clearly, it was effective. Is a distal trial necessary to kind of reinvigorate that market? The second part of the question is, just what do you consider successful in the Thunderbolt trial? Because if immediate revascularization is the endpoint, I guess, what do you consider kind of a good time reduction that we should be looking for in that trial? Thanks for taking my question.
Adam Elsesser (Chairman and CEO)
Yeah. Both really, really good questions. Let's start on the distal one. There's a lot of discussion, and SNIS just sort of prompted it. We hosted a symposium, dinner symposium. We, hugely attended, probably one of our biggest attended ones we've ever had at SNIS. So there's a lot of interest in this topic of distal. And there's not an easy answer. There's not a lot of consensus. I think people would not mind having the data that is directly supportive of our Red 43 aspiration catheter doing this, which is really considered the sort of catheter of choice to do these cases. What does that trial look like? Who would randomize for people who already believe in it? No one is going to want to randomize those patients because they already believe it. I think it's a tricky trial, but there's a lot of conversations that are happening.
We're privy to most of them about what is next and what should be done here. We'll let you know when there's some additional information to share. Yeah, I agree with you that it's an open question. Do we need it? The question around what the Thunderbolt study should show, I'm not going to answer that quantitatively, obviously. I will just sort of point to the thing that Thunderbolt does. Thunderbolt is not the catheter. Thunderbolt is the product that attaches to the catheter and to our aspiration source and creates modulated aspiration. Its only work is done when the catheter is already at the face of the clot, and it's about how fast the clot can come out. Not the case itself time, but the clot removal time. That's what we want to measure.
Obviously, we have all the traditional endpoints that the trials have, but that's the thing that physicians are going to be looking for. Does that change? There's no standard for people. If you talk to as many physicians as I talk to, everyone kind of has their own gut feel of what their average time is, not their best time, which they share with most people, but their actual average time when you look at hundreds of cases. That's what I think we'll be measuring up against.
Ryan Zimmerman (Managing Director and Medical Technology Analyst)
Thank you. Congrats on the quarter.
Adam Elsesser (Chairman and CEO)
Thank you. Yeah, thank you.
Operator (participant)
Our next question comes from the line of Michael Sarcone with Jefferies. Your line is open.
Michael Sarcone (Analyst)
Good afternoon, and thanks for taking the question. You've got a few things going on here. You have the Salesforce ramping. You're ramping Ruby XL. And you also mentioned you're moving past some China headwinds. Do you think maybe just in the context of guidance, can you talk about how you're thinking about seasonality and quarterly cadence through the back half of the year?
Adam Elsesser (Chairman and CEO)
Obviously, there's traditionally been a sequential gain unless there's some unusual thing like product launches or something that changed that between. You sort of build a little in the third quarter and ramp into the fourth quarter. That is, the fourth quarter is always the best unless, again, something changes because of product launches. I expect that to be somewhat the same here now. That's just been that way forever.
Michael Sarcone (Analyst)
Okay. Great. The second question is just on the US VC business. Really strong growth the past three quarters. You mentioned, obviously, the market's not growing at that level. Do you think maybe you can just give us an update on where you stand on the market share front in pulmonary embolism and DVT?
Adam Elsesser (Chairman and CEO)
We all try to guess based on all the data sources that everyone gets. I think it's always sort of a fool's errand to put an exact number on it. We have obviously continued to gain share both in DVT and PE. I think we've made enough movement in DVT to be over 50%. I think we've made a pretty significantYe dent in the PE business. I'm pretty excited about the cases we've seen, the excitement around that from new users. I think if a STORM-PE is positive, that will simply continue, if not accelerate. I think we're in pretty good shape. Again, it comes down to the product. It is a product that just does what it's supposed to do, simpler and faster and safer than other technologies. At the end of the day, I think I've always said almost all doctors will ultimately use the best product.
I think that's just what we're seeing right now, that the proprietary sort of computer assisted vacuum thrombectomy, or CAVT, is just a unique animal that isn't really something that anyone else can do and copy because of, obviously, IP. We're in pretty good shape with it. We're not done. We're going to keep making it better. I think everyone knows that.
Michael Sarcone (Analyst)
Great. Thanks, Adam.
Adam Elsesser (Chairman and CEO)
Thank you.
Operator (participant)
Our next question comes from the line of Joanne Wuensch with Citi. Your line is open.
Joanne Wuensch (Managing Director)
Thank you for taking the question. Congrats on the quarter. I'd like to spend just a minute on STORM-PE with the announcement of the completion of enrollment. It seems to me that this is sort of the next wave of growth for you. With the enrollment being completed, can you walk us through the timeframe to get from here to approval to commercialization and if there's anything specific that we should be aware of on that path? Thank you so much.
Adam Elsesser (Chairman and CEO)
Yeah. No, thank you. It's a great question. First of all, our product is already cleared for use in PE. There's no approval or clearance necessary here, which is great. It really is just data that is going to be looked at by the larger community, not just interventionalists, but everyone involved in the treatment of PE cases of patients to determine what the best treatment for these patients are. Again, this is the first trial in the world that has finished that compares anticoagulation to anticoagulation and a mechanical device, in this case, our specific mechanical device. I think that's what is driving the excitement because that's the standard of care versus something new.
I think if the trial is positive, it will obviously have some significant impact on the thinking around the physicians who are charged with caring for these patients and their referral patterns and what they want to do with these patients. Again, to remind everyone, we're 10+% penetrated this market just in the U.S. There's a lot more patients that can benefit. Again, if the trial is positive and shows that, I think it will have some significant impact. Again, on a market that is all in bigger than our stroke market. It's a huge impact and a huge win for potentially lots of patients, again, assuming the trial is positive.
Joanne Wuensch (Managing Director)
Thank you.
Adam Elsesser (Chairman and CEO)
Thank you.
Operator (participant)
Our next question comes from the line of Matthew O'Brien with Piper Sandler. Your line is open.
Samantha Munoz (Equity Research Analyst)
Hi, this is Samantha on for Matt. Thank you so much for taking our question. I guess we'd like to continue that train of thought with STORM-PE. Assuming the data is positive, and we definitely think it will be, how do you anticipate the market evolving? Is it appropriate to think of it like stroke where you saw this almost immediate increase in thrombectomy usage after the readout?
Adam Elsesser (Chairman and CEO)
Yeah. We don't know. Let's wait till we get the data and present it this fall, which isn't that far away. That being said, the one thing that I want to point out that's different about stroke, and this is somewhat important. With stroke, you had and still have what I alluded to earlier, this fundamental structural problem in that the patients aren't always going to a hospital that does stroke intervention treatment. Sometimes they have to be moved. Are they always moved? That is a structural impediment. You don't really have that in PE. There's got to be some hospital, one place here or there where maybe that's true. The vast, vast majority of places where a patient will show up with a PE, they could be treated if that is becoming the standard of care. It's a very, very different dynamic.
Adam Elsesser (Chairman and CEO)
It's something that, having spent the better part of 10 years sort of working on, I'm incredibly excited to not have that impediment and be able to just do the right thing for all these patients. Again, assuming it's positive.
Samantha Munoz (Equity Research Analyst)
Right. Yeah. Thank you so much for that. It makes a lot of sense. We just have one follow-up on the neurovascular thrombectomy market and specifically, I guess, kind of what the medium vessel occlusion, I guess, portion of the market is doing. I guess, could you talk a little bit about your exposure, maybe what percent of your stroke business happens in these medium vessel occlusions, and what revenue, if any, is impacted?
Adam Elsesser (Chairman and CEO)
Yeah. That's a really, really good question. It's hard to pinpoint that exactly because if you take the medium, as you call it, our catheters that would typically be used there are a RED 62 and sometimes a RED 43. Both catheters that are also used in other places. It's hard for us to know and pinpoint that with the kind of numerical precision that I would like and you probably want. What I can tell you is it really is very much a site-specific thing. It isn't just the interventionalist making those decisions. In fact, most of the time, it's a non-interventionalist making those referral patterns. It has happened. We have heard of centers that have become more conservative. I don't think it's the overwhelming view. Obviously, we did really quite well this quarter. It continued to take share. The overall market didn't grow as much.
Could that have had some small impact on that number, potentially? We don't know that definitively.
Samantha Munoz (Equity Research Analyst)
Okay. That's helpful. Thank you. I appreciate it.
Adam Elsesser (Chairman and CEO)
Yeah. Thank you.
Operator (participant)
Our final question comes from the line of Chris Pasquale with Nephron. Your line is open.
Chris Pasquale (Partner and Senior Analyst)
Thanks. I wanted to circle back to international embolization, just given how much that segment drove the upside this quarter and really deviated from the recent trend, both sequentially and year over year. First, Adam, if you wouldn't mind, could you quantify the China contributions just so we can tell the extent to which that order might have driven the beat? And then second, I think your original guidance for the year called for international embo to be about flat, for the U.S. to be up maybe mid to high single digits. Both pieces are running ahead of that midway through. How are you thinking about the four-year growth for that business?
Adam Elsesser (Chairman and CEO)
Yeah. First of all, on China, they do not order any of our coils, so it has nothing to do with our embo number at all. As it relates to the larger thing, I mean, they have some access products. They have some stroke products and thrombectomy products, rather. As it relates to the larger international business, I think you know that we have been in a rebuilding mode for a year and a half. I think we have been pretty open about that process as we want to sort of get the right products there. We want to be at a margin that is affordable in markets that do that. I think what we are seeing is the benefit of a lot of that work.
I am pretty excited to see that work. It is easy to focus on our US business where there is so much good happening there. It is also really important that we do not forget about the rest of the business. I am excited that we can do all of it at once. I think, again, none of this is linear, but I think we are in pretty good shape for a while as we move into not just this year, but in future years, both in our US, but also internationally.
Chris Pasquale (Partner and Senior Analyst)
Okay. Thank you.
Adam Elsesser (Chairman and CEO)
Thank you.
Operator (participant)
Ladies and gentlemen, that concludes our question and answer session. At this time, I would like to turn the call back over to Ms. Furlong for closing remarks.
Cecilia Furlong (Director of Business Development)
Thank you, operator. On behalf of our management team, thank you all again for joining us today and for your interest in Penumbra. We look forward to updating you on our third quarter call.
Operator (participant)
This concludes today's call. We thank you for your participation. You may now disconnect.