Erica Rogers: Yes. I’ll take the last part of that, Travis. And Lucas can help me out on the first bit. On randomized controlled trial, look, we’ve been in partnership with CMS for a very long time on the collection of real-world evidence. And as you’ll recall, that whole reimbursement paradigm for Silk Road for TCAR went into being at the behest of the Society of Vascular Surgery and in combination with FDA and CMS. And so this was well thought out from the beginning that real-world evidence was really what they wanted to see here. The paradigm of stenting the carotid artery and stents themselves has been well studied for many decades. So the new question was really how does TCAR do in the real world. And that is satisfying the CMS goal of access into the real world and extending this into broader patient populations and in the hands of more physicians.
And so keep in mind that CMS is not the customer here. The customer are patients and physicians. And physicians and referring physicians are deeply satisfied with the comparisons that have been made in these highly rigorous propensity matched studies that have been published in very high-impact factor journals such as JAMA.
Lucas Buchanan: Yes. I’ll take the economics question, Travis. So we’ve done deep work here and a lot of that work is in our investor deck relative to carotid endarterectomy. But obviously, we’ve been competing with transfemoral CAS all this time as well. And if we up level for 1 second, generally, the economic argument comes into play when there’s true clinical equipoise, right? But for all the reasons we’ve stated, there are many referring to treating physicians that don’t believe there’s clinical equipoise here. So the economic argument is less relevant, right? We’re talking about major complications and major impact on patients’ lives. But if we just held — if we assume clinical equipoise, TCAR and CAS cost about the same.
There are elements of each procedure that are more expensive and less expensive. But this assumption that the transfemoral CAS is cheaper and more profitable for hospitals, it’s simply not borne out by the data. We work very closely with a very well-known Stanford professor and consultant who runs a consulting effort for medtech companies, very well known. Jon Peach from Stanford, his consultancy is called [Indiscernible] and there’s very marginal differences in the cost of care for TCAR to transfemoral CAS. But shortly, strokes are very expensive. They add 5 days on average to the length of stay, including 3 in the very expensive ICU environment. So they’re expensive at a dollar level but they’re also extremely expensive at a reputational level.
So our sales team is equipped to go in and have these economic arguments. It’s, again, typically why would I do more TCAR relative to what I’m mostly doing which is CEA. And we’ve been winning that battle with data and we’re well prepared to continue to win that battle for accounts that want to talk about it relative to transfemoral CAS.
Operator: Our next question comes from Kristen Stewart of CL King.
Kristen Stewart: Sorry to beat a dead horse here but just to go back to the revenues per procedure. I’m just struggling a little bit to understand why it shouldn’t be more than $7,000 for the next 2 quarters in light of all your progress with ENFLATE and just kind of thinking about things rebounding off of that first quarter.
Lucas Buchanan: Yes. Kristen, thanks for the question. I mean, you’re right, the primary tailwind is ENFLATE, right? It’s a very small impact but it will be a larger and larger one over time. And the headwind is just what is the par level inventory that hospitals are carrying in this more mature [ph].
