Adam Elsesser: Yes, this is Adam. I think that’s a really important question, so I appreciate you raising it. I think that opportunity, particularly on the trials where they are looking at the core impact parked in saying we could treat a lot more of the patients than we thought we could treat is a really huge development. We haven’t called that out specifically because we want to wait and see that that’s what behavior is happening in sustainable form before we sort of get too excited about it. But I don’t disagree with you. I think from everything I have heard and all the conversations I have had with neuro physicians, that is a real likely possibility. It’s relatively new. It is sort of summer time and so to talk about it as a clear happening trend, it’s a touch early.
But I think all the conversations that led to believe that, that could grow the market. Obviously, so far, given the timing of those, the gains we have seen have been share based. But yes, I mean I would be delighted for patients if we could treat more and more patients and they can get better. And obviously, that would have a very, very positive impact on the neuro part of our thrombectomy business.
David Rescott: Okay. Great. Thanks and congrats on the quarter.
Adam Elsesser: Dave, thank you.
Operator: And your next question comes from the line of Shagun Singh. Your line is open.
Shagun Singh: Great. Thank you so much. Adam, I was hoping you could provide your views on GLP-1, just related to Novel preclinical [ph] data that is studying GLP-1 impact on peripheral artery disease. The primary and study completion date isn’t until mid-2024, but we have seen an impact on stocks in the medtech world just on top line readouts that have come out before. So, just anything you can share with us ahead of it to instill confidence in the PAD space.
Adam Elsesser: Yes. Thank you for that question. Obviously, it’s been a topic in the investment world, less obviously in the physician community directly. Look, there is – we are the healthcare company. We obviously applaud any innovation of whatever form that can help people be healthier and feel better. That being said, if you look at just the sort of factual statement, obesity, for example, is not a direct causation of thrombus formation. It is a risk factor. There are lots of risk factors, age and I could list 20-plus risk factors. It is not one of the top risk factors even. But that being said, if you were to look at that and say, maybe you could have a several percentage point impact in the long, long run and the number of patients that have clot, which I am not willing to necessarily concede, but if it did happen, it wouldn’t be a material question as it relates to our numbers because we are less than 10% penetrated in a market.
And then by the time we were experiencing that, it would be many, many years, if not decades away. The other analogy and I think for folks who are in stroke or cardiovascular disease of any kind is really looking at statins. 20-plus years ago, they held out huge promise. And obviously, they have been very valuable. They have – they become widely adopted. The use of them, very commonplace, the price has come way, way down to very, very affordable. But it hasn’t in any form, it’s helped in certain things, but it hasn’t changed at all the number of patients who have clot in their body. It just hasn’t. And so notwithstanding the other benefits that it has brought, it hasn’t lowered the number of patients with clot in their body at all.
So, I think from a – are we going to be necessary as a company and our innovative products continue to be used at the scale where we have ambition around, I think the answer is pretty clear, we will be.
Shagun Singh: Got it. That’s really helpful. And just as a follow-up, I wanted to get some color on the plus 20% growth that you have called out in ‘24. Should we think of that as a base case, it’s still – we haven’t entered 2024? And then also, you are exiting the year at 28% to 31% growth in Q4. So, what does that imply for ‘24 and the plus 20% being a base case or let’s take this any color that would be helpful. Thank you for taking the questions.
Adam Elsesser: Yes. Look, I don’t want anyone to misinterpret what I have said. What I have said at the investor conference in September was that 20% plus growth was achievable. And then I reiterated that I strongly believe that today. I also said, please give us the courtesy and time, again, not trying to hide anything, not trying to [indiscernible] that, but to get through this year and do what we traditionally do is give formal guidance with the exact numbers on our next quarterly call. Again, please don’t read into that, but that’s somehow anything other than commenting or reiterating what I have already said.
Shagun Singh: Fair enough. Thank you so much.
Adam Elsesser: Thank you.
Operator: You next question comes from Citigroup. Your line is open.
Joanne Wuensch: Thank you very much. It’s Joanne Wuensch. And I apologize if you have addressed this. There is a lot going on. Was there any stocking in the quarter? And can you comment a little bit on what you are seeing in terms of – it looks like there is some neuro weakness and how that happened U.S. versus o-U.S.?
Adam Elsesser: Yes. Well, let me address the stocking. We have quickly addressed that earlier, so I will do it quickly. We don’t typically do stocking. Our initial orders are one or two units at the most, just to get people started. So, that was – that’s not part of our business model and hasn’t been. Jason can address. We had a neuro question, which Joanne has already asked as well.
Jason Mills: Yes, it was. But I am happy to go through it. So, as I mentioned just a little earlier and apologies for the rest of the people on the call just for going over this again. But our neuro business actually achieved what we expected it to in the quarter. It executed very well. So, just to give you a bit more context, the neuro franchise grew 17% year-over-year. And if you remember, we articulated earlier in the year, in fact, at the outset of guidance that we expected vascular growth writ large to be higher than corporate average growth and neuro would be lower. And we sort of – I think we got some pushback to that after the first half of the year because neuro was stronger. But we understood the cadence of our business.
We understood that we were going to see more seasonality in distributor variances in our neuro business internationally in the second half of the year, which is why we stuck with that. And of course, if we don’t guide specifically to neuro grows this and vascular grows that, I think models just didn’t maybe account for that. But in our view, our neuro business and neuro team is doing exceptionally well.
Operator: And there are no further questions at this time. Ms. Hamlyn-Harris, I will turn the call back over to you.
Jee Hamlyn-Harris: 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 fourth quarter call.
Operator: This concludes today’s conference call. You may now disconnect.
