Penumbra (PEN) Q2 2025: U.S. Thrombectomy Jumps 22% as Dedicated Sales Teams Fuel Segment Focus
Penumbra’s Q2 showed decisive execution as U.S. thrombectomy growth and a split commercial team strategy sharpened competitive focus across key franchises. International headwinds eased, while operational investments in sales force expansion and new product launches set up the back half for margin and revenue gains. Guidance was raised, with management signaling confidence in both near-term delivery and longer-term margin trajectory.
Summary
- Sales Force Split: Penumbra’s move to dedicated thrombectomy and embolization teams intensifies commercial focus and execution.
- Clinical Data Catalyst: Completion of STORM-PE trial positions company for a pivotal inflection in pulmonary embolism treatment adoption.
- Margin Expansion Path: Gross margin improvement remains on track, with new products and productivity gains expected to drive further upside.
Performance Analysis
Penumbra delivered strong double-digit growth, with total revenue up 13.4% year-over-year, led by robust U.S. thrombectomy performance and a rebound in embolization and access sales. The U.S. market accounted for nearly 77% of total revenue, with international sales down modestly due to lingering China headwinds, though management expects a return to international growth in the second half.
The thrombectomy franchise, which includes mechanical clot removal devices, was the primary engine, growing 13% globally and over 22% in the U.S., powered by continued adoption of proprietary CAVT (computer-assisted vacuum thrombectomy) products. Embolization and access, a segment focused on controlling or preventing blood flow in vessels, also posted near 14% growth, underscoring the early success of the new RubyXL coil. Operating margin improved, with adjusted EBITDA margin expanding to 18.1%, reflecting both top-line momentum and operating leverage despite targeted investments in commercial hires.
- U.S. Thrombectomy Share Gains: Penumbra’s VTE (venous thromboembolism) business outpaced market growth, with management estimating over 50% share in DVT and rapid gains in PE.
- International Recovery: China’s impact lessened, and other regions contributed to sequential growth, indicating stabilization after a period of restructuring and margin-driven market exits.
- Margin Dynamics: Gross margin of 66% reflected temporary inventory build for new launches, but remains on track for 70% by 2026, with the RubyXL product accretive to margin.
Cash flow was robust, with a $45.7 million sequential increase in cash and no debt, providing flexibility for continued investment in innovation and commercial infrastructure.
Executive Commentary
"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."
Adam Elsesser, Chairman and CEO
"As we move to the second half of 2025, we expect headwinds in China to ease, resulting in a return to growth across all of our international regions. Importantly, we remain well-positioned to deliver our long-term gross margin profile of 70% by the end of 2026."
Maggie Yuen, Chief Financial Officer
Strategic Positioning
1. Dedicated Sales Teams for Focused Growth
Penumbra implemented a structural shift by splitting its sales force into dedicated thrombectomy and embolization teams. This move is designed to allow each team to specialize, deepen customer engagement, and better support new product launches such as RubyXL. Leadership cited the complexity and breadth of their product portfolio as the main driver, with over 50 new embolization reps and 40 vascular clinical specialists added to support this effort. Early field feedback and operational ramp are already in place, with management expressing confidence in accelerated returns through the back half of the year.
2. Clinical Data as a Market Catalyst
The completion of the STORM-PE randomized controlled trial is a potential inflection point for the pulmonary embolism market. This is the first global study comparing mechanical thrombectomy plus anticoagulation versus anticoagulation alone, and results—expected this fall—could meaningfully shift referral patterns and standard of care if positive. Penumbra’s CAVT platform is already cleared for PE, so a favorable readout could unlock immediate adoption without regulatory delay.
3. Portfolio Innovation and Pipeline Progress
Penumbra continues to invest in next-generation technologies across both peripheral and neurovascular segments. The launch of Red 72 Silver Label in stroke thrombectomy, ramp of RubyXL in embolization, and anticipation of Thunderbolt (a modulated aspiration device for neuro) highlight a pipeline designed to capture share and expand addressable markets. Ongoing clinical studies such as STRIDE II further support product differentiation with high-quality evidence.
4. Margin Expansion and Operational Leverage
Despite near-term investments in commercial headcount and product launches, management reiterated a clear path to >70% gross margin by end of 2026, with operating margin expansion expected to outpace gross margin gains. The margin profile is supported by both favorable product mix and productivity improvements, with the RubyXL coil specifically called out as margin-accretive.
5. International Turnaround and Market Diversification
International sales, while down year-over-year due to China, are stabilizing and expected to return to growth. The company has completed restructuring, exited lower-margin markets, and is now seeing traction from new product launches in key regions. This diversification reduces reliance on the U.S. market and positions Penumbra to capture global thrombectomy and embolization growth as reimbursement and product access improve.
Key Considerations
Penumbra’s Q2 was defined by strategic execution, with leadership balancing near-term investments and long-term market positioning. The company is leveraging clinical data, commercial focus, and innovation to drive sustainable growth.
Key Considerations:
- Sales Force Ramp Impact: Front-loaded hiring is expected to drive incremental growth in both thrombectomy and embolization, with minimal disruption as teams are already operational.
- Product Launch Timing: Early shipments of RubyXL and anticipated Thunderbolt clearance could create step-changes in segment growth and margin structure.
- Clinical Data Leverage: The STORM-PE trial, if positive, may accelerate adoption in PE, a large underpenetrated market, without regulatory lag.
- International Recovery: Headwinds in China are moderating, and other international regions are contributing to sequential growth, diversifying revenue streams.
- Margin Progression: Gross margin remains on track for structural improvement, with product mix and operational scale as primary drivers.
Risks
Risks remain around the timing and impact of new product launches, particularly Thunderbolt, which is still in FDA review. Margin expansion depends on successful execution of sales force ramp and product mix improvement, with potential for month-to-month variability. International market recovery, especially in China, is subject to regulatory and macroeconomic uncertainties.
Forward Outlook
For Q3 2025, Penumbra guided to:
- Continued sequential revenue growth driven by thrombectomy and embolization launches
- Gross and operating margin expansion as product mix improves
For full-year 2025, management raised revenue guidance to $1.355 billion to $1.37 billion (13% to 15% YoY growth) and maintained guidance for U.S. thrombectomy growth (20% to 21%) and margin targets:
- Full-year gross margin and operating margin guidance unchanged
Management highlighted several factors that will influence results:
- Sales force ramp and commercial execution in embolization
- Potential STORM-PE trial readout as a catalyst for PE adoption
Takeaways
Penumbra’s Q2 confirms its competitive momentum in U.S. thrombectomy, with commercial and operational investments positioning the company for sustained market share gains and margin expansion.
- Execution on Commercial Focus: The sales force split is already operational, setting up the company for sharper execution and product adoption across both thrombectomy and embolization.
- Clinical and Pipeline Catalysts: Upcoming STORM-PE data and Thunderbolt launch could drive inflections in growth and standard-of-care adoption, especially in underpenetrated markets.
- Margin and Cash Flow Trajectory: Positive operating leverage and cash generation provide flexibility for continued investment and support the path to 70%+ gross margin.
Conclusion
Penumbra’s Q2 2025 results underscore a business in transition from broad-based growth to targeted, segment-driven execution. With commercial and clinical catalysts on the horizon, the company is positioned to extend its leadership in thrombectomy and embolization while driving profitability and operational scale.
Industry Read-Through
Penumbra’s results signal that focused commercial execution and clinical data generation are becoming critical differentiators in the interventional device market. The move to dedicated sales teams reflects a broader industry trend toward specialization as portfolios expand and products become more technically demanding. The STORM-PE trial’s randomized design sets a new evidence bar for mechanical thrombectomy in PE, with potential to drive adoption and shift referral patterns across the sector. Margin expansion tied to product mix and operational leverage is a theme likely to resonate with other medtech peers facing similar scaling challenges. International rebound, especially post-China headwinds, provides a roadmap for global medtechs navigating regulatory and reimbursement volatility.