InspireMD (NSPR) 2026 年第二季法說會：召回影響與 FDA 催化劑

重點摘要

• 儘管自願召回 CGuard Prime 135 頸動脈支架系統，InspireMD 仍公布 2026 年第二季營收為 180 萬美元，與去年同期基本持平。
• 在持續需求的推動下，國際營收成長 21% 至 210 萬美元，而非受匯率波動影響。
• 與召回相關的客戶折讓 73.4 萬美元及 61.2 萬美元的存貨跌價損失，拖累毛利轉為虧損 80 萬美元，毛利率為 -43.7%。
• 淨虧損從 1,320 萬美元擴大至 1,430 萬美元，每股虧損則從 0.26 美元收窄至 0.17 美元。截至季末，現金、現金等價物與可交易證券總計為 3,040 萬美元。
• 管理層表示，用於 TCAR 的 CGuard Prime 80 以及用於 CAS 的原始 CGuard 平台的 FDA 潛在決策目標仍定於 2026 年第四季。
• 預計裁員近 20% 將可每年節省約 900 萬美元，完整的成本改善效益預計將在 2026 年第四季顯現。

核心財務業績

營業費用增加主因是美國商業化團隊的人力成本增加，以及用於 SwitchGuard NPS 與用於 TCAR 的 CGuard Prime 80 之研發、臨床與法規支出增加。一般及管理薪酬費用的下降抵銷了部分增幅。

業務與營運表現

5 月初宣布的自願召回事件，因暫停銷售 CGuard Prime 以及退還未使用的 CGuard Prime 135 產品款項，進而影響了美國營收。在召回生效前，該公司產生的美國銷售額不足一個月。

國際業務仍是主要的營收驅動力。InspireMD 在美國以外的市場已售出超過 75,000 個 CGuard 植入物。管理層表示，目前正在審視定價與利潤率假設，以提升國際業務除了營收成長之外的利潤貢獻。

針對重新設計的 CGuard Prime 135 輸送系統，該公司已確定所需的修改，並正在進行設計驗證與性能測試。管理層表示，重新設計的輸送機制表現符合預期，包括在具挑戰性的解剖結構中也是如此。

該公司亦在 SwitchGuard 神經保護系統的關鍵 CGUARDIANS III 研究中納入了首位患者。管理層形容早期受試者入組情況與研究者的回饋皆相當正面，同時指出試驗擴展將部分取決於可用資源。

管理層指引

• 用於 TCAR 的 CGuard Prime 80：在獲得主管機關審查的前提下，管理層持續看好可能於 2026 年第四季獲得 FDA 批准。
• 用於 CAS 的原始 CGuard 平台：該公司目前預計 FDA 將於 2026 年第四季做出決策。管理層表示，此時間表反映了測試要求以及留出公司與 FDA 回應週期的需要。
• 用於 CAS 的重新設計 CGuard Prime 135：管理層繼續以 2027 年上半年重新進入美國市場為目標；若測試要求與 FDA 審查途徑順利，亦有機會提前獲得決策。
• SwitchGuard：該公司維持先前討論的 2027 年下半年獲得批准與上市的時間表，同時強調入組進度將會影響具體時間。
• 降低成本：大多數重組措施已在進行中。管理層預計在 2026 年第三季實現部分成本節省，並於 2026 年第四季完全顯現調整後成本結構的效益。
• 重組費用：InspireMD 預計 2026 年第三季將列支 90 萬至 120 萬美元與資遣費及相關成本對應的費用。

風險與觀察重點

重返美國市場的時間仍取決於 FDA 的審查。對 CGuard Prime 135 而言，主要不確定性包括是否需要進行額外的生物相容性測試，以及 FDA 是否同意對設計變更進行加速審查。

召回事件持續影響營收、毛利率與存貨價值。雖然管理層認為該問題在技術上已解決且可控，但商業化重新上市的時間仍取決於監管核准。

SwitchGuard 的開發進度取決於臨床患者入組情況及可用資源。該公司也在保留現金與維護足夠商業能力以備重返美國市場之間取得平衡。

分析師問答亮點

分析師高度關注審查時程。管理層將原始 CGuard 系統預期獲批時間從 2026 年第三季推遲至第四季的原因歸因於對測試、公司回應及 FDA 審查週期的合理考量，而非新發現的產品問題。

關於 CGuard Prime 135，管理層表示設計驗證測試正在進行中，並已向 FDA 提出預先遞件申請（pre-submission request）。若能免除額外的生物相容性測試並獲得更快的審查流程，可能會縮短目前 2027 年上半年的時間表，但公司並未承諾加速。

在商業就緒度方面，InspireMD 表示已留任關鍵的第一線人員，並透過理賠資料、區域規劃和客戶核准流程精進其上市策略。管理層指出醫師的意願依然強烈，但這些聲明反映的是公司在獲得監管核准前的評估。

管理層將 SwitchGuard 視為其長期 TCAR 策略的核心基石，因為每項 TCAR 手術都需要同時使用支架與神經保護裝置。該公司認為，若獲得批准，同時提供這兩款產品可進一步提升營收與利潤率空間。

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管理層陳述

Operator

Good morning, and welcome to InspireMD Second Quarter 2026 Earnings Conference Call. [Operator Instructions] As a reminder, this call is being recorded for replay purposes.

Joining us today from InspireMD are Marvin Slosman, Chief Executive Officer; and Mike Lawless, Chief Financial Officer.

During this call, management will make forward-looking statements, which are based upon management's current expectations, beliefs and projections, many of which, by their nature, are inherently uncertain. These forward-looking statements involve risks and uncertainties that may cause actual results to differ materially from those expressed in such forward-looking statements. More detailed information about the company and the risk factors that may affect the realization of forward-looking statements is set forth in the company's filings with the U.S. Securities and Exchange Commission, including its annual report on Form 10-K, quarterly report on Form 10-Q, any updates in its current reports on Form 8-K as well as InspireMD's press release that accompanies this call, particularly the cautionary statements made in it.

During the call today, the company may also discuss certain non-GAAP financial measures. For a more detailed discussion of these non-GAAP financial measures and historical reconciliation to the most closely comparable GAAP measures, please refer to the company's earnings release. This call contains time-sensitive information that is accurate only as of today, August 17, 2026. Except as required by law, InspireMD disclaims any obligation to publicly update or revise any information to reflect events or circumstances that occur after this call.

It is now my pleasure to turn the call over to Marvin Slosman, Chief Executive Officer. Marvin, please go ahead.

Marvin Slosman

Thank you, operator, and good morning, everyone. The second quarter was an important period for InspireMD. While our reported financial results reflect the accounting impact of the voluntary recall of our approved CGuard Prime 135 carotid stent system, the quarter was defined by the actions we took to strengthen the business, sharpen our execution and position our company for a successful return to the U.S. market. Over the last several months, we've remained focused on 4 priorities: optimizing our international business, advancing our key regulatory programs and milestones to U.S. market reentry, implementing design enhancements to the CGuard Prime delivery system and aligning our organization and cost structure around these priorities. I believe we are making meaningful progress on each of these objectives.

Notwithstanding our temporary absence from the U.S. market, our total revenue was essentially unchanged from the second quarter of last year. It's important to note our international business continued to perform very well, growing approximately 21% year-over-year, reflecting continued physician adoption and strong demand for CGuard across our international markets. At the same time, our reported U.S. revenue reflects customer credits associated with the voluntary recall announced at the beginning of May. Those credits more than offset gross U.S. product sales during the quarter and therefore, obscure the underlying performance of the business.

Importantly, our confidence in the CGuard implant remains the foundation value driver of our business and will continue to be the asset that builds our market leadership regardless of which delivery method is chosen for each patient's need. The clinical outcomes and evidence we've developed over many years have set a new standard of care, translating to physician enthusiasm and utilization, which remains strong, giving us confidence as we anticipate our U.S. relaunch. We continue to believe CGuard is the most differentiated technology available for carotid revascularization and stroke prevention.

Turning now to our CGUARDIANS II submission of approval of our CGuard Prime 80 platform for TCAR. We recently announced an outstanding 30-day results from the trial, which we believe strengthen our pending submission. In fact, our latest discussions and feedback from FDA remain constructive and interactive and all signals point to potential approval in the fourth quarter, as we previously indicated. Once approved, the CGuard Prime 80 platform would essentially double our addressable market by offering our implant for TCAR in addition to CAS procedures. We also enrolled the first patient in CGUARDIANS III, our pivotal study evaluating next-generation SwitchGuard neuroprotection system. Taken together, we're encouraged by the progress across our comprehensive TCAR programs.

Also, as previously noted, our submission of the original CGuard platform for CAS, clinically proven in over 75,000 global OUS cases continues, and based on the progress to date, we currently expect a decision from FDA in the fourth quarter of this year. Should these anticipated approvals be realized, we would have both TCAR and CAS platforms commercially available before the end of the year, giving us the opportunity to address the entirety of the approximately 75,000 annual stenting procedures in the U.S.

When we spoke to you last quarter, we outlined a clear plan to address the improvements for the CGuard Prime 135 CAS delivery system. Since then, we've identified the required design modifications, initiated validation and performance testing and continue to work closely with the FDA as we advance these improvements with a completed early submission of our pre-sub dossier. These modifications and testing have gone exceedingly well, and we are optimistic that the associated time lines of first half of 2027 for market reentry of this platform has the potential for an earlier approval.

While this has clearly been a challenging time for the company, I believe our ability to weather these setbacks has made us a stronger and more focused organization. The CGuard 135 delivery system modifications and remediation is well understood. The path forward is clearly defined, and our team remains fully focused on implementation.

During the quarter, we also took decisive actions to better align our organization and cost structure with our near-term priorities. These decisions allow us to focus our resources on the regulatory and commercial milestones that we believe will have the ability to create the greatest long-term value for our shareholders. We also believe we've created a leaner, more efficient and focused organization that is better positioned to execute, not only to return CGuard to the U.S. market, but to expand access for our physicians and patients they treat.

Before turning the call over to Mike, I'd like to leave you with 4 key messages. First, the underlying fundamentals of our business remain strong as demonstrated by continued international growth, physician anticipation for our CGuard implant as what we believe is the best treatment for carotid disease with clear line of sight for our U.S. market relaunch.

Second, we believe the voluntary recall is proving to be a well-defined and manageable event. We understand the issue. We've identified the solution, and we are executing against a clear regulatory pathway to reestablish traction and growth.

Third, we continue to advance multiple regulatory catalysts, including CGuard Prime 80 for TCAR, the redesigned CGuard Prime 135 platform for CAS, the original CGuard delivery system as well as our next-generation SwitchGuard neuroprotection system.

And finally, we've aligned our organization and cost structure to support these priorities while positioning InspireMD for long-term sustainable growth.

While we still have important work ahead of us, I believe today, we are a more focused and disciplined company and ultimately have better positioned ourselves for success.

With that, I'll turn the call over to Mike to review the financials. Mike?

Michael Lawless

Thank you. As Marvin described, the second quarter financial results need to be interpreted in the context of the voluntary recall that we announced at the beginning of May. For the second quarter of 2026, total revenue was $1.8 million, which was essentially flat with the revenue for the second quarter of 2025.

The recall action affected our reported revenue in 2 ways. First, we ceased commercial sales of CGuard Prime late in April, so we generated less than 1 month of sales in the U.S. before the recall took effect. Second, we booked a $734,000 credit for the return of the CGuard Prime 135 product that had not yet been consumed by our customers. International revenue was $2.1 million, representing growth of 21% versus the same quarter a year ago. This performance continues to reflect the growing global demand for our CGuard stent platform. The entirety of international growth was driven by continued demand, while changes in foreign exchange rates were immaterial.

Gross profit for the second quarter of 2026 was a loss of $0.8 million or negative 43.7% of revenue compared to a gross profit of $0.3 million or 17.6% of revenue for the second quarter of 2025. This decline in gross margin resulted primarily from the $734,000 credit to revenue that I described previously and a $612,000 impairment charge for CGuard Prime 135 inventory on our books that was no longer commercially viable as a result of the recall.

On a non-GAAP basis, which excludes the impact of the recall-related customer credits and impairment charge, adjusted gross profit was $0.6 million. A reconciliation of adjusted gross profit to gross profit, the most directly comparable GAAP measure, is included in today's earnings release and posted in the Investor Relations section of our website.

Total operating expenses for the second quarter of 2026 were $13.7 million, an increase of $0.4 million compared to $13.3 million for the second quarter of 2025. The increase was primarily due to greater headcount-related expenses for the U.S. commercial team and higher development, clinical and regulatory expenses related to SwitchGuard NPS and CGuard Prime 80 for TCAR, partially offset by lower general and administrative compensation expenses.

Financial income was $121,000 as compared to a loss of $132,000 for the second quarter of 2025. Net loss for the second quarter of 2026 totaled $14.3 million or $0.17 per basic and diluted share compared to a net loss of $13.2 million or $0.26 per basic and diluted share for the same period in 2025. As of June 30, 2026, cash and cash equivalents and marketable securities were $30.4 million compared to $54.2 million at the end of 2025.

As Marvin discussed, we have proactively taken actions to reduce our cost structure and improve our financial flexibility and operational efficiency. Included in these efforts was a workforce reduction action initiated in the third quarter that reduces the number of positions in our organization by almost 20% and saves the company approximately $9 million on an annual basis. We expect to incur a restructuring charge of between $900,000 and $1.2 million in the third quarter to account for the severance and related costs associated with this workforce reduction event.

This concludes our prepared remarks. We will now open the call for questions. Operator?

Operator

[Operator Instructions] Our first question comes from Adam Maeder with Piper Sandler.

分析師問答

Adam Maeder

A couple for me, and maybe we can just start on the CAS side of the business. So first, original CGuard delivery system approval timing for U.S., if I heard correctly, was Q4. I think in the last earnings call, you mentioned Q3. So a little bit of a wiggle there versus prior expectations. And I don't mean to nitpick over a couple of months, but can you just talk about kind of what's driving the shift there? Any color you can give us on your recent interactions with FDA? That's question one. And then I have another 1 or 2 for you guys.

Marvin Slosman

Thanks, Adam. Thanks for the question. I think the wiggle, as you mentioned it, is we're just trying to be realistic about the regulatory time frames as always, request from FDA and just general time frames. We have testing that has been required and is completed, and we're just trying to make sure that we're understanding a realistic approval time line here relative to the workload, our responses to FDA and so forth. So I think we're on top of the details and what's necessary and required. So it's really nothing more than that. We just want to be realistic about giving ourselves some room here on these responses and FDA's response back, specific to the legacy system.

Adam Maeder

Yes. Perfect. Okay. And then if we switch over to CGuard Prime, the delivery system there. Good to hear you're still tracking towards first half 2027 approval for that technology. I guess my question is what's left to do before submission? And it would be really helpful if you could put a finer point on FDA submission timing as folks just try and understand how derisked the first half '27 approval it truly is. And then I had one more for you guys.

Marvin Slosman

Sure. The progress on the 135 technical and the Prime system on the 135 Prime technical improvements is really solid, Adam. In fact, we feel confident that we've not only solved the delivery challenges, but produced a solution that performs exactly as we anticipated with the trackability and even in challenging anatomy and so forth. And so the delivery mechanism performs well. We are in the process right now of doing DV testing and making sure that all of the technical work that we've done from the engineering group is now stacking up in terms of measured approach.

So we're confident in the system. We're confident that we've solved it, and this is our platform for the future. So we originally guided around a first half 2027 approval. We think that, that remains realistic. There's a couple of long poles in the tent that we're still sorting out related to biocomp testing, the statutory review process that FDA puts on these things. We have submitted early our pre-sub request to FDA to review all of the results to date and our anticipated response. We hope that, that gives us a little more clarity and is more favorable. But if we can eliminate some of these long pole items, we believe that there is a possibility that we could pull that approval process in. But right now, we're calling the first half of '27 as being realistic, and we're optimistic that we can make those improvements.

Adam Maeder

Okay. And maybe just one last one. Sorry, it's another kind of regulatory question. But just flipping over to SwitchGuard, which I think is important, your proprietary TCAR system. So I think in June, you enrolled the first patients in that study. Just any comments you can give us, color you can give us, Marvin, on the enrollment progress there and kind of how that trial is advancing? And just from a time line standpoint, I just want to confirm that you're still tracking to back half 2027 for U.S. approval and launch.

Marvin Slosman

Yes. The enrollments thus far have gone very well. We don't take any of that for granted. Obviously, this is the first time SwitchGuard has been used in human applications. So I think the investigators are very pleased with the performance, and we continue to enroll in the trial. Our expansion of that trial will, to a certain extent, depend on the resources that are available to us. But so far, we have initiated sites that we believe are high volume and enthusiastic about SwitchGuard and continue to progress in those enrollments with the time line that you had previously mentioned as being what we're calling at this point. Obviously, the enrollment process will determine time lines. But so far, we're really pleased about the responses and the performance of the device itself.

Operator

Comes from Frank Takkinen with Lake Street Capital Markets.

Frank Takkinen

I wanted to follow up on the comments around some of the cost saving initiatives. First, when should we expect those to be fully realized? Understanding there's going to be some restructuring expense that occurs in Q3. When should we see kind of the first quarter of the refreshed operating expense run rate? And then you made a comment related to a 20% reduction in headcount. Can you maybe talk to the distribution of where those 20% came from inside the organization?

Michael Lawless

Frank, good questions. So in terms of the timing for when we'll realize those cost savings, those -- the vast majority of those actions that we described have already been set in motion. I would expect that we should see the full impact of that -- those cost savings in Q4 of this year. There will be some partial savings in Q3, but there will be also some offsetting costs associated with restructuring. So from a clean standpoint, I would say Q4 should be a good view of what the new cost structure looks like.

Marvin Slosman

Frank, let me jump in on the second part of your question there. Obviously, we want to make sure that we're anticipating a very aggressive relaunch, and we've built a plan to enable that commercial readiness built for that momentum. So even though we're conserving our financial resources to extend the cash runway, we're trying to strike a balance in maintaining the commercial readiness to do so. So reducing these layers makes a lot of sense to us. But at the same time, I think we're continuing to maintain the strength of our commercial organization to make sure that we're ready in a fairly tight window here that we're out of the gate relaunching and doing so properly with a great team on the field. So we're -- we feel good about the ability to do that.

Frank Takkinen

Okay. Very helpful. I just wanted to follow up on one of Adam's questions on the Prime system. Just hoping you can put a little bit of a finer point on what the kind of key variable to sliding that time line is. I know you've mentioned kind of maybe earlier part of first half '27, if you're able to accelerate that process a little bit, but you're remaining conservative and to keep the first half '27 guidance. But what is the key variable that kind of changes that time line? And is that something that's more in your control? Or is that related to maybe how quickly the FDA can process?

Marvin Slosman

Yes, it's a great question, Frank. So as I mentioned, there's 2 testing scenarios that we're looking at here. Biocomp testing, it takes a bit of time. We don't believe that is necessary, but we need to validate that with -- obviously, with FDA and their review of this under the pre-sub scenario that we have set up. And then the statutory review process, we would be looking for more of an accelerated review of those changes that we've made to the prime. And if FDA agrees with that, those could pull those time lines in significantly.

But again, no commitments at this point. We're still guiding around all of those factors being as they are. So first half of '27 is what we're calling at the moment. But given the fact that we believe we've solved this problem technically with minimal implications from a technical point of view, we're hopeful that FDA agrees with that assessment and that we can pull that in.

Operator

Our next question comes from Marie Thibault with BTIG.

Marie Thibault

I wanted to ask a question here on sort of the updated commercial strategy. If all goes well, you'll have the relaunch and then other launches to follow pretty quick succession here. So I know you have a new Head of Sales and Marketing, maybe a smaller tighter team on the commercial side. So just any updates on how you're thinking about the launches commercially? Any changes to the strategy? Any thoughts on VAC committee processes, all of those sorts of details would be helpful.

Marvin Slosman

Sure. Thanks, Marie. Glad to have you on the call, by the way. So I think what we've spent a lot of time doing over the last month or so is making sure that we are optimizing the structure of our field organization for the folks that performed really well on our initial launch. As you know, we take a very deliberate approach to where carotid procedures are through claims data and territory management. We're looking very closely at time to productivity of our team. So this is a very deliberate and structured approach. The playbook for our commercial launch and relaunch has been looked at very closely.

We have a new Head of Sales and Marketing who has real clarity on how we go about doing that. And so we're thrilled with the group that we have on the field, their ability to understand where their customers are and what the anticipated and pent-up demand is going to be. And so obviously, that playbook will be executed, and we feel like that the group that's with us now will be able to reestablish our commercial presence quickly.

VAC committees and otherwise, we continue to look closely at where we have those approvals and making sure that customers understand time lines and our process here. So that part of the work, we spent a lot of time looking at to make sure we get the full benefit of the value of our relaunch. We know that there is pent-up and anticipated demand for this product. And this voluntary recall gave us the opportunity to take a quick pause and make sure that we're being very efficient and realistic and aggressive about our relaunch plans. So that feels very good.

Marie Thibault

Okay. That's wonderful to hear. A quick follow-up here. You mentioned, I think, international grew over 20% this quarter. What's been driving that? That's a really nice bright spot. I'm curious if that's a sustainable growth there.

Marvin Slosman

Yes, Marie. I think it's a great question. Our OUS business has matured very well over the last several years. Remember, we've been in the OUS markets now for years, sold over 75,000 implants. We think, first of all, the performance of this device drives world-class outcomes and that the physicians in our OUS markets are very accustomed to that being the new standard of care, which we hope to translate into the U.S. market as well.

We've grown that OUS business significantly and nicely over time, but we also recognize the need to pivot a bit and look for higher margins and margin expansion in those markets. It's obviously not as a robust economic market as the U.S. And so we're beginning to look closely at fine-tuning those pricing and margin assumptions so that we can count on that business not only being a great top line business, but being able to contribute at least partially on the bottom line. So we're thrilled to have the results that we do in our OUS market.

Operator

Our next question comes from Jeremy Pearlman with Maxim Group.

Jeremy Pearlman

First, I guess, are you in touch with the physicians who are using the recalled 135-centimeter delivery system? And what's their take on the time line? And are they going to be happy to reengage with the company and the CGuard Prime once it's hopefully recleared?

Marvin Slosman

Yes, Jeremy, great question. We are absolutely in touch with all of our customers, including the current users and new users. The anticipation in this marketplace is palpable. When we launched this product, we saw a terrific reaction to a new technology that came to market after 20 years of older technology. And we're, of course, in touch with all of those customers. I think they're excited and anticipating having this product back in their hands is unanimous. It's consistent, it's unanimous. That's why our sales team, we've kept them together and allowed them to continue to cultivate those relationships.

And the expectation is as soon as we have approval of the 135 as well as the approval on the 80 for TCAR, we will be able to transfer that interest and enthusiasm into revenue in a quick fashion. So that's the work of the sales organization right now is to prepare for that relaunch and the feedback from customers is excitement and enthusiasm for having it back in their hands.

Jeremy Pearlman

Okay. That's great to hear. And then just last question for me. Regarding how important is the SwitchGuard to the long-term TCAR strategy, let's say, versus just the CGuard 80? I mean, how much does that -- obviously pending FDA approval, how much does that materially expand your addressable TCAR market? Like -- and what would -- why would a physician, let's say, use the entire SwitchGuard system versus a prior system with just the CGuard 80-centimeter?

Marvin Slosman

Yes. It's very fundamental to our overall TCAR strategy. The fact is that for every TCAR procedure, there's an implant use, there's a stent use and then a neuroprotection device that's also used in the procedure, and we felt it was important to have both. We've made some improvements on the current predicate in the market that's approved with our SwitchGuard. So we think we will have a device that has some features and functions that the customers have been looking for that are otherwise unavailable.

Obviously, the sales dollars and margin associated with that product are significant. And so the ability to address the entirety of the TCAR market with both the implant and the neuroprotection system here are really fundamental to our TCAR strategy overall. So we think we benefit by better technology and obviously, internally with higher revenue and margin opportunities. So it remains a fundamental part of our overall plan.

Operator

That concludes today's question-and-answer session. I'd like to turn the call back to Marvin Slosman for closing remarks.

Marvin Slosman

So I'd like to thank everyone again for joining the call today and the continued interest in InspireMD. We certainly recognize we have important work ahead of us, but we believe that we've made meaningful progress over the past several months. We've got a clear path forward, multiple important regulatory catalysts ahead and a team that remains fully focused on execution. We appreciate the continued support and look forward to updating on our progress next quarter.

Operator

This concludes today's conference call. Thank you for participating. You may now disconnect.