Medistim ASA (MEDI) Earnings Call Transcript & Summary

Good morning, everyone, and welcome to Medistim's Fourth Quarter and Preliminary Financial Results for 2025 presentation. My name is Kari Krogstad, and I'm joined with the CFO, Thomas Jakobsen. And we will go through this usual agenda, starting with the highlights. And I'm very pleased to being able to report a new record for sales in the quarter, reaching NOK 182.3 million in Q4. This means that we are continuing the high growth all through the year that we've seen in the first 3 quarters, ending with 20.6% growth in this fourth quarter. We can see that there is quite a small currency effect when we are comparing to the currency in the same quarter last year. But still adjusting for that, the total sales will be -- could be 21.7%. And we're seeing that our own products are doing really well, and the sales is up 25%. And it is AMERICAS region that is really leading the way with 44.3% currency-neutral growth. We also see that EMEA, Europe, Middle East and Africa, has a very strong quarter, this fourth quarter being up 24.4%. Our Asia Pacific region is down by 24.2%. And as we have consistently reported all through the year, we have to expect quarter variations from Asia Pacific, but we also expect it to see a solid year, which we will show. The third-party products has a small 2.2% growth in the quarter, but we know that they had a tremendous start and will finish the year very strong. Also, the operating profit is very strong, NOK 42.3 million, up 63.8% from the same quarter last year. And I just want to mention that the EBIT margin of 23.2%, although being a lot higher than the margin that we reported in the same quarter last year is impacted by an increase in IT infrastructure expenses of NOK 5.8 million. So this obviously had a negative impact. And actually, this EBIT margin would have been about 26% without it. But I will leave to my colleague, Thomas, to give a bit more background for this. But a very decent ending of the year. This is then taking us to a record year for both sales and operating profit. So almost reaching NOK 700 million in revenues, completing the year at 24.4% growth. Slight currency effect and adjusting for that, the total sales is up 25.8% and we're seeing that our own products sales is as high as 28.3% growth. Again, it is AMERICAS that is leading the way, up 40.5%, but also Asia Pacific, extremely strong at 40% growth and also EMEA with a decent 7% growth for the year. We know that we have a lot of highly penetrated countries in that region. And also our third-party products having a record year and growing 12.7% in '25. This takes us to an operating profit record at NOK 196.2 million, up almost 50% from last year and also giving us the strong EBIT margins at the high 20s that we would like to see of 28%, and this is very much driven by the strong sales of our own products through the direct sales channel. So based on these results, the Board will suggest to the general assembly a dividend of NOK 8 per share, a total of NOK 146.2 million. So this means that we are able to adding another record year to our history and also meaning that we continue to deliver on our promise of profitable growth consistently over time. So with that, I will leave the word to Thomas.

Thank you very much, Kari. I will, as usual, take us through the financials for the quarter, but also for the year. Since Kari is going through sales revenue more in detail for geography and products, I will not go into that detail here, but I need to mention that with record sales and especially sales through our direct markets and especially the U.S.A., this improves our margin going from 77.8% to 80.2%. Having said that, on the negative side, we actually have here a tariff expense of almost NOK 4 million included in the cost of goods sold related to the tariffs implemented in the U.S., which for Norway is 15%. Salary and social expenses increases as we discussed in previous quarters, we've strengthened our commercial team, but also our R&D team and operations. At the same time, we also have a record year, which means that we have higher commissions and also bonuses related to the results that we are now presenting to you. Then you would expect maybe on other operating expenses with Kari's note that NOK 5.8 million is expense related to IT infrastructure. And when you compare that to last year, the expense is almost the same. And the reason for that is that we had also a very high expense level in the fourth quarter in 2024 related to congresses and especially the launch of the INTUI software. In addition to that, we also had recruitment expenses to our new commercial sales team. So both fourth quarter 2024 and fourth quarter 2025 is then relatively speaking, high when we look at these quarters. So what is this IT infrastructure external expense? Well, we do have an ERP system, a CRM system and a PDM system that is today on-premise, which we are lifting to the cloud -- to a cloud solution. And if we were to lift this from one on-premise solution to another on-premise solution, this would obviously be an asset for the company. All the expenses related to that work would be company property and therefore, an asset. When we do this from on-premise to a cloud solution, still the coding that's Medistim related is still an asset. But according to the international accounting rules, when you are using standard configurations and standard setups, that part of the project lifting it to the cloud is not an asset, and therefore, this part of the project is expensed. And what we've seen here for the fourth quarter, NOK 5.8 million has therefore been expensed, and that's the explanation why we have this situation. Even so, EBITDA increases from 21.4% to 27.1%, ending at NOK 49.3 million. Depreciation is slightly higher than last year. But even so, EBIT percentage increases from 17.1% to 23.2%, ending at NOK 42.3 million. Net finance is currency-based realized and unrealized gains and losses, ending positively for the quarter with NOK 5.5 million. All in all, profit ends at -- before tax ends at NOK 47.8 million and profit after tax increases 78% and ends at NOK 38.1 million for the fourth quarter. So going into the total year, yes, we almost end the year at NOK 700 million. So this is definitely a record for Medistim. When we look at margins, same explanation as for the quarter. However, the total tariff expense in 2025 is also NOK 4 million, which means that before the tariff was introduced in the U.S., we shipped over all the products that we were able to ship to the U.S. to avoid the tariff on those goods, which means that we've been selling from an inventory in the second and the third quarter of 2025 on products that are not affected by the tariff. So we do now see that in the fourth quarter, we have the full effect of the tariff. And going forward in '26, we will continue to have this effect as long as this tariff of 15% is valid. Salary and social expenses increases and the explanation is the same as for the quarter, only larger numbers. Other operating expenses also increases, and we have been very much pushing our sales team to be out with face time to the customers. So the increase of the expense is related to our commercial teams being out there traveling, visiting customers, and we have very good experience that the more face time we have with our customers, the better results we will have on sales. So that is something that the new commercial team has been pushing. EBITDA percentage increases from 27.7% to 31.6% for the year. EBIT margin also improves from 23.3% to 28% and ends at NOK 196.2 million. Net finance, I can also add in addition to currency that we have effect of -- positive effect of interest on additional cash, which amounts to about NOK 5 million. All in all, profit before tax, first time is over NOK 200 million for Medistim and ends at NOK 206.8 million and profit after tax ends at NOK 159.2 million, up over 50% compared to last year. So a record year of top line and bottom line. Balance sheet, our intangible assets increases. 3 major reasons for this. We have the 2 development projects ongoing, but we also have the IT infrastructure project, taking our systems from on-prem to the cloud, increasing the intangible assets. When it comes to inventory, we see that inventory level is at the same level as last year. However, our inventory level peaked by the end of the second quarter at almost NOK 175 million. And the reason for this was related to the period when supply chain was an issue, and we placed orders, which we now have honored and this has been delivered. So going forward, from a lot of our critical components and some of our most expensive components, we do not expect to do purchase on these components in 2026. And we will then -- the orders that we're now placing is then for delivery in 2027. This means that going forward in 2026, I would expect to see inventory levels actually decreasing. Accounts receivable increases natural when we increase sales. Our cash position is solid, ends at NOK 212.1 million. And as Kari mentioned, our Board, based upon the solid cash position, a very good year 2025 profit-wise and a good forward-looking situation in '26 and going forward, the Board has suggested to the general meeting to pay a dividend of NOK 8 per share, which is NOK 146.2 million in cash payment in total. Our equity liability, we have a strong balance sheet, more than 70% equity. Also, our long-term liability is not related to bank debt. So we have no interest-bearing bank debt. And this is then related to extended warranty and service contracts, which is here deferred income, NOK 11.5 million. And we also have a total of NOK 49.3 million in obligations related to our lease contracts, of which NOK 37.5 million is long term. Some key figures. We see that our earnings per share increases quite nicely in the fourth quarter ends at NOK 2.08. So Krones is the Norwegian termination for NOK. For the year, it ends at NOK 8.71 per share, which is up and corresponding to the development in our profit, obviously. So again, a strong year. Our cash flow is also positive. We have a strong cash flow from operations, both for the quarter and for the year. Our investments, NOK 36 million in total for the year, we have NOK 22 million related to product development. We had NOK 10 million related to our IT project as the 2 major investments that we are involved in at the moment. Cash from financing ends at NOK 122.7 million, and the majority of that is the dividend we paid in May of NOK 109.5 million. So net -- change in cash is positive with NOK 32.8 million, and we end the year with a cash position of NOK 112.1 million, which is also a record actually going out of the year when it comes to cash. So by that, I leave the word again to Kari to continue this presentation. Thank you.

Yes. So let's take a deeper look into the various products and segments starting with the Flow-and-Imaging systems In units. So we see that we have volume growth in all regions, giving a net 5 more Flow-and-Imaging units sold this quarter. And we are, of course, very happy to see this development both for the quarter, but even more so for the full year. We see strong volume growth in AMERICAS, which is in volume growing by 84% and also in Asia Pacific, up 75%. And as we all know, this is really the most important product from Medistim, it is really what separates us from competition, having these 2 modalities in 1 system, both imaging and flow. And it's the higher value, higher priced products. So it's very important for us to see increase in sales of this particular product. EMEA, as we can see, is down for the year by 14% but it's growing on the Flow system side. When we are selling more imaging systems, we also expect to see more imaging probe sales. This particular quarter, it is down, but we are noting that the third quarter this year was exceptionally strong, so not really a big surprise. And again, for the full year, with the very strong performance in the AMERICAS of the sales of the imaging products, we also see the strong volume growth on the probe side with a growth 81%. Asia Pacific and EMEA was done in volume for imaging probes. We're then looking at the Flow-only systems, we are down for the quarter. And -- but for the full year, Flow-only system volume was down in AMERICAS by 36%. Of course, this is related to the high growth that we're seeing on the imaging side in AMERICAS, But we're also seeing that Asia Pacific also growing on imaging is actually growing 35% on the volume side with the Flow-only systems, which is very strong. EMEA also up 6% on the volume side here. So we are seeing after a couple of challenging years that the imaging sales are gaining momentum again. And Flow-only units then rose 4.3% to 121 units, while the combined Flow-and-imaging unit surged at 39% to 92 units. So about 43% of the total number of systems was actually including the imaging in 2025. Also when it comes to flow probes in units, we've had a great quarter and a great year. So for the quarter, we're growing 26.5% in units. And for the full year, flow probe volume sales is up 20.7%. This is very much driven by the strong 17% growth in capital sales of all systems. And yes, so as a conclusion here, it is both the capital system sales, but also increase in use that is driving the demand for these consumable flow probes. Looking at the regions in a little bit more detail. So starting with AMERICAS. And as we know, more than 90% of the revenues from this region actually comes from the United States. We are ending Q4 at NOK 86.1 million, meaning 44.3% currency-neutral growth. And we are seeing that total capital system sales declined by 2 units, but we are selling 2 more imaging units, and these are really high-priced products. So it really compensates for the lower number of units. We also saw strong probe sales for the quarter. Flow probes up 56%, imaging probes up 15%. So extremely good performance in the U.S.A. And also, we are seeing positive contributions from the smaller parts of this region. Our new direct market Canada has shown a very positive performance all through the year and had a growth of 56% in the fourth quarter. Latin America is a very small region here. Closer look into the AMERICAS. Here, we can see what the impact of selling more capital systems on the Flow-and-Imaging configuration. This is really what drives the revenues from AMERICAS. So 28.6% growth in volume for the quarter, but 84% growth in volume for the full year. Also, when we're counting the number of procedures coming from sales, whether it's from the smart cards and the lease agreements that we have or directly from selling flow probes to the capital customers, we are noting that this is increasing tremendously, 72.6% from the flow probe to capital customers for the quarter and 60% for the year. And this actually ends at over 100,000 procedures, flow procedures in Americas for the full year. So this is definitely a new record. And when we are then adjusting for some of these probes being sold to Vascular customers, we are now estimating that we have an adoption rate in the U.S., not at 37% as we reported last year, but at 40%. Also, it's interesting to note that procedures from imaging probes to capital customers is growing nicely, ending at 83% growth for the year. Looking at Asia Pacific. So as I stated, it's a slow quarter. It's down 24%, but up 40% for the full year. So definitely a success and finally being out of the challenging period after the transition into a direct organization in China. China is the biggest region here, sales were down 49% for the quarter, but up 32% for the year, ending at NOK 45.7 million. And we have to remember that actually all countries in Asia Pacific depends on distributors. And still in China, where we have our own employees, and we are, of course, supporting end users as well, we still are relying on distributors and agents, and this will always give variability in the quarterly sales as we have consistently informed. Sales to Japan were down for the quarter, but is showing a solid year, 71% growth, ending at, I would say, a normalized NOK 20.6 million when we're looking at historical sales. And as we have announced earlier this month, Medistim will now go direct in Japan. I will get back to that in a few minutes. Also, the other countries and other Asia Pacific distributors are actually contributing very positively, 95% growth for the quarter and 38% growth for the year, ending at NOK 25.8 million. Europe, Middle East and Africa, NOK 56.2 million in sales in Q4. That is currency-neutral growth of 24.4%. So a really strong finish from the EMEA region. It's particularly a strong quarter for the direct markets, which we, of course, like to see. We're talking about Spain, Germany and all the Scandinavian countries, where we see currency-neutral increase of 13.5% for the quarter. Also sales through distributors was up with currency-neutral increase of 34.3% for the quarter, ending at this 7%, which again, I feel is a decent result, but we have ambitions to grow this in the future. Third-party products, 2.2% for the quarter, 12.7% growth for the year. This is a highly diversified product portfolio. Mentor and their breast implants, Icare and their ophthalmology products and A.M.I with their urology and proctology products are the biggest contributors here. And we remember that it was ophthalmology products sold to new hospitals in Norway that was really driving the high growth that we saw in 2025. And this took the third-party product portfolio to a new record of NOK 101 million. So this summarizes and shows that it's a really good performance, I would say, from all regions, but I have to highlight the contributions from AMERICAS and the fact that we are growing 35.9% in total from a very high base of NOK 237 million to NOK 322 million in 2025. Taking a look at the split of Cardiac versus Vascular sales. We're happy to see that we see strong growth in both Cardiac and Vascular products. But we are continuing to see that the Vascular surgery products continue to have higher growth rate than the Cardiac surgery products. And we're also seeing that it's gradually taking a larger share of the total sales of own products. And in '25, we ended at almost 20% of the revenues from own products coming from Vascular. So this is also a positive development. If we look at the split of Flow-only products versus the Imaging systems and probes, we then see that after this challenging period in '23 and '24, the revenues from imaging products are back with the highest annual growth so far at 47.4%. And now the revenues from sale of Imaging products make up 31% of sales of own products. Also, when we are checking how we're doing with our recurring revenues coming from sales of paper procedure, smart cards and lease revenues and also sales of our probes, we are seeing that '25 is ending at -- just above 70% as a percentage of recurring revenues. So pretty much consistent with what we've seen over the years. Then allow me to provide some comments also on how we're doing in implementing our strategy, reminding everyone that our vision is actually to place a Medistim system in every operating room all over the world. That's a big task, and we are making progress, but there is still very high growth opportunities here. A couple of years ago, we launched our midterm goal of being reaching NOK 1 billion in sales in a few years. And with the NOK 700 million that we are delivering in 2025, we are well underway of achieving this goal. And the strategy to actually get there is this combination of converting the high penetrated Flow-only CABG market to Flow-and-Imaging. It is to continue to grow in those markets where we are underway with flow and getting increased adoption of our flow technologies in every market. It's also to be flexible and provide entry-level solutions in price-sensitive markets and absolutely to build a position in Vascular surgery, which I just showed that we are also progressing on. Expanding direct market coverage is also a very critical part of our strategy. And now on the 2nd of February, we sent out a press release to say that as of 16th of March, Medistim opens a direct sales office based in Tokyo. And I can report that we already have a solid team with experienced leader in place. And our situation in Japan is well known. We have 90% of the approximately 17,000 CABG surgery procedures performed in the market. And as just reported, we ended 2025 with sales to our current distributor there at NOK 20.6 million. So the growth opportunity is, of course, coming from our experience of getting closer to the end users is really critical to maximize the value from the market. And the first thing that will happen is that we will capture the distributor margin. And then longer term, we will have the opportunity to continue to grow with our Flow product to convert from Flow-only devices to Flow-and-Imaging devices. We have a decent uptake of imaging system, but it's still only maybe around 35%. So there's definitely continued growth opportunity in CABG surgery. And then comes an untapped potential from Vascular procedures as well. Another part of our growth strategy is to support activities that will grow adoption in underpenetrated markets for Flow. And clinical marketing is critical. So on the 24th of February, we announced that we will sponsor a new trial, SMARTFLOW, which is a randomized clinical trial in CABG surgery. And we're very excited about this study. First of all, it's going to be led by Professor Mario Gaudino, a very prominent surgeon at Weill Cornell Medicine in New York. And this opinion leader is the first author on the consensus paper published in circulation in 2021, where a group of surgeon experts made 10 expert statements, including the very famous transit-time flow measurement should be used in every CABG case. So it was an extremely positive and supportive article in a prominent paper supporting our technology. At the same time, in the conclusion in this paper, they stated that, of course, it is desirable to perform a large randomized clinical trial to really -- to provide the best evidence for this claim. And that's exactly what they are now seeking to do. This is a quote from Professor Mario Gaudino. He says that most existing studies evaluating TTFM are small, observational and methodologically heterogeneous. Although expert consensus supports its use, the lack of adequately powered randomized evidence remains a barrier to widespread adoption in clinical practice. This is his words. He also says that SMARTFLOW has been designed as the first appropriately powered randomized trial to rigorously evaluate intraoperative graft assessment with TTFM in CABG. And by generating high-quality randomized data on the impact of TTFM on early graft failure and by providing a platform that can be extended to assess clinical outcomes, the SMARTFLOW program has the potential to inform future guideline recommendations and promote a more consistent evidence-based approach to intraoperative graft assessment. So this is Professor Gaudino's words. The study design of the SMARTFLOW is that it's expertise-based. That means that 1,242 patients that will be enrolled in the study will be randomized to either a surgeon, an expert surgeon, doing flow measurements routinely or to a surgeon who is not doing flow measurements. So this is the concept of an expertise-based trial. And the graft patency will be assessed with Medistim's MiraQ TTFM. And the imaging modality will also be available, but it's not mandatory to use that in this study. And we're talking about 20 centers in the U.S., in Canada, in Europe and in Asia that will partake in this trial. And the goal is to evaluate whether TTFM reduces the incidence of graft failure within 1 to 3 months post surgery as assessed by coronary CT angiography. So there are plenty of studies that are already providing evidence for this, but this is going to be a higher quality, larger study randomized that will hopefully provide really the next level of evidence for this. And providing a positive outcome here, the study may be extended to evaluate the impact of TTFM on longer-term clinical outcomes, and that would include myocardial infarction, repeat revascularization, survival and quality of life. When it comes to Medistim's enrollment here, of course, it's completely scientifically independent trials. We have nothing to do with the interpretation of results or anything. And the study is primarily supported by philanthropic donations and federal funding, but Medistim is then serving as the only industry sponsor, and we will contribute with, I would say, a pretty modest USD 500,000 over the duration of the trial. This will, of course, be a great opportunity for us to facilitate upgrades to imaging in those centers that haven't already started using imaging, and it's a great way of also getting our newest INTUI software into the hands of these very good centers. We are also facilitating the study with our Case Cloud solution for data collection storage and analysis, the same as we're doing in the PATENT study. So with a good, I would say, great probably '25 behind us and also already moving into '26 with opening up a new market for us in Japan and also sponsoring and participating in this exciting new trial to support our CABG surgery market. We are moving into 2026 as one team, making bolder moves with excellence accelerated. So with that, I think we will open for questions.

Yes. And we have a number of questions today. The first one is on Japan. Congratulations on the opening of an office in Tokyo. How do you see the growth opportunities in Japan? And will you focus on developing the vascular market there?

Yes, I can comment on that. So first of all, I think we will -- our ambition is to run a more efficient operation in Japan with our own people on the ground. And as I explained, we still have growth opportunities in CABG surgery, first and foremost, from converting from the Flow-only system to Flow and Imaging. But certainly, vascular surgery is also adding growth opportunities. And I might add that the leader of -- the General Manager of our Japanese office actually is coming from a company, a medical device company serving the vascular surgery community. So he is well connected to vascular surgeons in Japan and will really be a great champion for us in our endeavor there.

It's another one on Japan. When you went direct in China, we saw a longer period of low sales and negative margin impact. Should we expect a similar situation in Japan?

Well, we had some learning from our Chinese experience. And one of the learnings was that we have shortened the transition period from 12 months to 3 months. And with the 12 months transition period in China, the distributor had the opportunity to fulfill their pipeline to a much larger extent because of having 9 additional months to fulfill that. So with shortening this period with 2 to 3 months, we have seen actually a limited possibility for our Japanese distributor to do the same thing as our Chinese distributor did. And also, we have -- although we honor those orders that come in that is tender related that our distributor has worked through, we have also been very restrict on typically larger probe orders if that were to come in. Having said that, we haven't seen that as of yet. So we are actually quite optimistic that this Japanese transition will be much smoother than the Chinese one. And also, in addition to that, our position in Japan, where we have 19% coverage at least on CABG. We have a very strong recoverable revenue stream. And we do believe that in the first year of '26, we will at least have an EBIT margin or breakeven situation in Japan maybe even a slight positive contribution. But at least going forward into 2027, we are convinced that Japan will give us a positive contribution to our profits.

The next one is on the tariffs. The report indicates that price increases have been absorbing the tariffs in the U.S. How has the price increases been received in the market? And do you think the price increases can affect sales volumes going forward?

I take that too, Kari. Well, I don't think any customer will embrace a price increase as such. But having said that, we haven't seen any significant resistance in the U.S. related to the price increase either on systems or on probes, and we do see that capital sales are continuing to grow and also probe sales. And we introduced this price increase effectively end of June. And what we've seen at least on probe volumes is that flow probes in the second half compared to the first half increased with 38% in volume. And the same for imaging probe, which has increased 50% in volume. So, so far, we have not experienced that this price increase is actually decreasing volumes. It's rather the opposite. So going forward, we are quite optimistic that this price has been accepted.

We have more questions on tariffs. Does the NOK 4 million hit due to the tariffs imply that all the products sold in the U.S. in the fourth quarter were tariffed? Or will this number continue to increase as more and more stock run out that was not tariffed?

Fourth quarter, all products were tariffed. So that is the level that given the same sales volume in the U.S. going forward. So this actually started the last days in September actually in the third quarter. So fourth quarter is a full quarter of -- with full effect of tariffs.

Yes. And it's a follow-up on that. How high do you expect the annualized run rate for tariff expenses in the U.S. to be once all inventory is sold?

This is more or less answered and this is all dependent upon the level of sales in 2026. We do have a tariff of 15% -- 50% sorry -- 15%, sorry, 1-5. And the effect of that for us when we import to the U.S. is that we will have to increase our external pricing with 9% in order to neutralize it. And as we've seen from our report today, we more than neutralize it by actually increasing our gross margin. But to say how much tariff we would pay would kind of for me today, be impossible to say an exact number.

The next one is on the number of procedures. How come there is such huge jump in the procedures in the U.S.? Have there been higher demand for probes due to the announced price increases?

No, I would say that the increase in capital sales and the way that we are approaching it is also always selling sort of a start-up package with probes. And I think that has also probably grown with the new approach from the new sales team. So it's really connected to getting new users started with the Flow technology. Of course, some of this is then, you could say, for inventory, it will take some time for these new customers to consume all of these probes, but -- and that's what we're trying also to estimate when we're saying that adoption rate has grown. But with the large increase that we're seeing, part of this is definitely due to increased utilization.

Then we have some questions from the chat. Could you comment on development in larger EU economies and whether you have plans to go direct in new markets there?

Yes. Europe is still very interesting for us. We have pointed to Turkey as actually a new target market for the EMEA region. And Turkey actually have a higher CABG number of procedures, for instance, than Germany as, of course, the largest European country as such. So that's the progress we made in 2025, working with our distributors to refine our business strategy and model there. So that's definitely a new market that we will invest more deliberately in and provide more support to in '26 and onwards. Then we also have interesting, I mean, markets that's been worked by our distributors for a long time, we talked about Italy and France, which are currently at around 40% adoption of Flow technology. So obviously, a lot to do there, both to increase the use of Flow, but then also to convert to imaging and of course, the Vascular also to follow. So -- and in general, I can just give the answer that we have a list of countries which are of interest when it comes to being targets for the next go direct strategy.

Congratulations on the strong year. Regarding the U.S., what has been the main trigger for the strong growth acceleration there? Is it insurance policy changes or industry becoming more aware of the value proposition? And do you expect penetration to keep rising at a similar pace this year?

I think the fantastic results we're seeing from AMERICAS this year is a result of numerous factors. First of all, '23, '24 was more challenging on getting the capital sales of imaging systems as we pointed to. And really selling imaging, high value, high priced is very important for continued high growth. So getting back into that situation where actually the interest in our imaging technology is actually successfully converted into a sale that has happened in 2025. And that is, of course, due to our long commitment to positioning the imaging technology, and we're seeing the results of that. We never lost confidence that the surgeons wanted the imaging technology, but it was the economical situation in '23 and '24 that was postponing a lot of the sales processes. So that's one factor. But then I think the change with a strengthened commercial leadership and also intensive and significant investments in supporting our sales force in the U.S., but also in all our direct markets. We've done a lot when it comes to improving our training for our sales reps this year. We provided numerous events for training, both on the technical, clinical and definitely on the sales side of the sales process. So I think that also contributes very well. And of course, the attitude, the strategy from sales leadership, which is, I would say, more forward-leaning, more ambitious and definitely showing very much a can-do attitude. So I think it's multiple things. Of course, pricing, we have increased prices as well. That's also contributing. But as we have shown, this is combined with the increasing volumes as well. When it comes to whether this will continue, I think it will be very hard to keep it at the current or the '25 growth levels going forward. As I said, a lot of this is coming from the comeback of the imaging systems and probes, which were really low in '23 and '24. So that growth level will not be there in 2026. But the investments we made in the team and also increasing the confidence and going after the vascular opportunities will continue to provide opportunities and support further growth in the U.S.

The next question is on INTUI. INTUI has been mentioned in your previous presentations, how much of the growth last year was done to this new launch?

Yes, actually very little. We have to remember that we started selling the INTUI in the second half. And that means that we are then starting to introduce the INTUI into the sales -- the new sales processes. When it comes to quotes that were already out there based on the former configuration and former pricing, that was for the large part, just kept as it is. So I think we had a total of 8 INTUI sales in the second half. And then we also have to remember that for now, we are selling the INTUI for the cardiac-only systems. We're not making it available yet for the Ultimate systems and the Vascular systems. The Ultimate is the combined solution for both Cardiac and Vascular. So this really means that when we're going forward, more and more of our sales will be on the INTUI. That means that the upside from the INTUI launch is still ahead of us, which I think is a great thing.

You announced your support to the SMARTFLOW randomized clinical trial on TTFM reducing graft failure led by Prof Gaudino recently. Do you think this will affect Medistim sales going forward?

As I said, we're very excited about this study. I think it's that lacking piece of evidence that everybody has been talking about and found it very difficult to address because it will be costly to do a large trial like this. And also there are ethical aspects that we never got flow users, surgeons that are using flow to accept not to do the flow measurements on some of their patients. That's why they come up with this expertise-based randomization strategy. But I would again also point to the fact that we have achieved a very high adoption rate in many countries. I mean, 90% in Japan, 80% in Central Europe and Nordics and well underway in the U.S. with 40% right now. So I -- there's no reason to wait for the trial and think that we will not be able to grow. We will grow year-by-year without the data from this trial and also without the guidelines that can come out of it, which is, of course, many years ahead. So -- but I think the value of it is really to keep attention to flow technology and really the question of the value of using this technology versus not using it. So I think it will keep the topic relevant and interesting. It will be talked about in the conferences for the years to come, which is all positive for Medistim and for the sales of our product. So I do think it will be supportive. I don't think that we are depending on it.

Thank you. That was all the questions this time.

Thank you.

Then we say thank you for this time, and we will see each other for the first quarter report. Thank you.