Boston Scientific (BSX) Q4 2025 earnings call transcript

Thank you, Drew, and thanks to everyone for joining us. With me today are Mike Mahoney, Chairman and Chief Executive Officer, and John Monson, Executive Vice President and Chief Financial Officer. During the Q&A session, Mike and John will be joined by our Chief Medical Officer, Dr. Ken Stein. We issued a press release earlier this morning announcing our Q4 and full year 2025 results, which included reconciliations of the non-GAAP measures used in this release. The release, as well as reconciliations of the non-GAAP measures used in today's call, can be found on the Investor Relations section of our website. Please note that on the call, operational revenue excludes the impact of foreign currency fluctuations, and organic revenue further excludes certain acquisitions and divestitures for which there are less than a full period of comparable net sales.

Guidance excludes the previously announced agreement to acquire Valencia Technologies Corporation, which is expected to close in the first half of 2026, and Penumbra, which is expected to close in 2026, each subject to customary closing conditions. For more information, please refer to the Q4 Financial and Operating Highlights deck, which may be found in the Investor Relations section of our website. On this call, all references to sales and revenue are organic, and relative growth is compared to the same quarter of the prior year, unless otherwise specified. This call contains forward-looking statements regarding, among other things, our financial performance, business plans, and product performance and development. These statements are based on our current beliefs using information available to us as today's date and are not intended to be guarantees of future events or performance.

If our underlying assumptions turn out to be incorrect or certain risks or uncertainties materialize, actual results could vary materially from those projected by the forward-looking statements. Factors that may cause such differences are discussed in our periodic reports and other filings of the SEC, including the risk factor section of our most recent annual report on Form 10 . Boston Scientific disclaims any intention or obligation to update these forward-looking statements, except as required by law. In addition, this call does not constitute an offer to sell or the solicitation of any offer to buy any securities or solicitation of any vote or approval in connection with the proposed transaction with Penumbra. Boston Scientific will file the SEC registration statement on Form S-4 containing a proxy statement of Penumbra and a prospectus of Boston Scientific that will contain important information about Penumbra, Boston Scientific, the proposed transaction, and related matters.

At this point, I'll turn it over to Mike.

Impressive, Lauren. Thank you. Good morning. Thanks, everyone, for joining us today. In 2025, we achieved over $20 billion in sales and for the second year in a row delivered mid-teens growth, surpassing our financial goals that we set at the beginning of the year. This outstanding and highly differentiated performance was fueled by innovation and execution across our business units in the winning spirit of our global team.

In fourth quarter of 2025, total company operational sales grew 14%. Organic sales grew 13, achieving the high end of our guidance range of 11 to 13, with continuous strength across many of our businesses, including EP, Watchmen, IO, Endo, and ICTX. Full year 25, operational sales grew 19%, while organic sales grew 16, exceeding our guidance of approximately 15.5.

Q4 adjusted EPS of 80 cents grew 15%, exceeding the high end of our guidance range of 77 to 79 cents. Full-year adjusted EPS of $3.06 grew 22%, also exceeding the high-end of our guidance range of $3.02 to $3.04. On a full-year basis, we expanded adjusting operating margins by 100 basis points to 28%. Balancing dropped through on the strong revenue performance throughout the year, with the reinvestment back into the business to drive long-term growth.

Now for our 2026 outlook. We expect our differentiated financial performance to continue in our guiding to organic growth of 8.5% to 10% for Q1 and 10% to 11% for the full year. Our Q1 adjusted EPS guidance is $0.78 to $0.80, and our full year adjusted EPS guidance is $3.43 to $3.49, representing leveraged double-digit EPS growth of 12% to 14%. And John will provide more details.

I'll now provide some highlights in Q4 and the 25 results, along with comments in 26 outlook. So, regionally, on an operational basis, the U. S. grew 17% in the fourth quarter and 26% on a full-year basis, with exceptional performance across the business units, particularly EP, Watchmen, and ICTX.

Operationally, Europe, Middle East, and Africa grew 5% in Q4 and 3% full-year. Excluding the impact of the accurate discontinuation, full-year and MAIA growth would have been high single digits. EP also grew strong double digits in Q4 as we continue to lead with our ecosystem approach, offering differentiated technologies and comprehensive commercial support. As we look ahead to 2026, we anticipate momentum in EP and Watchmen to continue in Europe and growth to be higher in the second half of the year once the impact of the accurate discontinuation is annualized.

Now the Asia-Pac region. It grew 15% operationally in Q4 and 14% for the full year, led by mid-teens growth across Japan and China.

Japan's growth in the quarter was driven by Watchmen and EP, fueled by Opal mapping system placements, and increased feropulse cathode utilization, where we continue to gain share. China had another quarter of double-digit growth driven by EP, Watchmen, and ICTS, and we expect EP momentum to continue into 2026, supported by our recent NMPA approval of our FairWave NAB device, as well as indication expansion into the persistent AF population.

Now some commentary on our business units. Fourth quarter urology sales grew 13% operationally and 3% organic on a full-year basis, and the full-year basis grew 23% operationally and 5% organically. Our performance in Euro this year was below our expectations, and we expect that our overall business will return to market growth in 26, with supply chain issues behind us, new product launches, and the strengthening of our sacral neuromodulation franchise.

We look forward to expanding our pelvic health portfolio with a recently announced acquisition of Valencia, which is expected to close in the first half of 26. Endoscopy delivered organic growth of 8% in both Q4 and for the full year and delivered a very strong year. Q4 growth was driven by our endoluminal surgery, imaging systems, and endobariatrics franchises, with the later receiving positive reimbursement support for ESG procedures.

In December, we initiated a product removal for certain sizes of our Axios device due to a manufacturing variation. We do understand the issue and are working to bring these unique devices back to market in full by mid-year and anticipate lower endo growth in the first half of the year as a result.

Neuromodulation had an excellent quarter, growing 10% in Q4 and delivering 8% organic growth for the full year. Our brain franchise grew low double digits on a full-year basis, led by the Cartesia X and Illumina 3D offerings, providing the full benefit of directional stimulation, also improving efficiency and programming time. The pain franchise continues to strengthen and grew high single digits on a full-year basis.

This strong growth is a result of a deliberate strategy to expand our pain portfolio to bring options to the physicians, patients, and hospitals we serve. This was further strengthened by the close of the NALU acquisition, adding peripheral nerve stimulation, PNS, to our portfolio. And within the quarter, we received expanded reimbursement to coverage for the Intracept procedure, initiated a full market launch of the Intracept Edge stylet, designed to improve the treatment experience. Our cardiovascular segment delivers 16% growth operationally in organic in fourth quarter, and 22% operationally and 21% organic on a full-year basis.

In January, we announced an agreement to acquire Penumbra, which is expected to close in 26. Penumbra offers a highly-differentiated portfolio that operates in high-growth segments where Boston Scientific lacks offerings, including mechanical thrombectomy and neurovascular. The deal is both strategically and financially attractive to Boston Scientific and delivers significant value to patients and customers globally.

Within cardiovascular, interventional cardiology therapy sales grew 10% in Q4 and 8% on a full-year basis. We're very proud of the coronary therapies franchise, delivering double-digit growth in both a quarter and full year as we have shifted our underlying business to high-growth markets. Agent DCV has been a standout performer all year with this differentiated clinical benefit and reimbursement support, lifting our drug-luting technology growth to over 20% on a full-year basis.

We continue to make progress in other areas of the portfolio, and we're pleased to have completed enrollment in the FRACTURE trial, studying our seismic IVL system. We anticipate presenting data from this trial later this year and continue to expect this differentiates technology in the first half of 2017. In Q4, we did reorganize the reporting structure of our peripheral interventions divisions, and we've aligned the peripheral vascular business led by Cat Jennings with interventional cardiology therapies to amplify both commercial and R&D opportunities across similar technologies while retaining customer call point focus. This new business unit will now be called interventional cardiology and vascular therapies. oncology and embolization will continue led by Peter Patterson as a standalone business, and this structure will enable focus on this broad and unique portfolio.

The peripheral vascular business grew 6% organically in Q4, with operational growth at 15%. Our two-year growth in Q4 was driven by double-digit performance in TCAR, supported by the recent launch of EnRoute in China. Within the quarter, we completed our first cases in the U. S. with a seismic IVL system. We're excited to add this differentiated and complementary technology to our portfolio and expect to expand our indication to include below the knee in the second half of the year. Invena's low double-digit fourth quarter growth is driven by a continuous strength in Verathena and ECOS. We're pleased to have the high pytho, our clinical study in ECOS versus standard of care anticoagulants, accepted as a late breaker at ACC, to be presented on Saturday, March 28th.

Our interventional oncology and embolization business grew 17% operationally and 12% organically in Q4 and achieved nearly $1 billion in a full-year, 25 sales, operational growth of 16, and organic of 12. Q4 organic growth is driven by our category-leading embolization and cancer therapies portfolio with ongoing strength in cryoablation, which treats a broad number of cancer types. And as we look ahead, we expect to continue to outpace the underlying market growth supported by new product offerings, such as Therosphere 360 Y90 Management Platform, which is a web-based platform to simplify the entire process for patients and physicians.

Cardiac rhythm management sales grew 1% organically in both the Q4 and for the full year 25. On a four-year basis, our diagnostics franchise grew high single digits and now represents nearly 20% of our overall CRM business. In core CRM, our high-voltage business grew low single digits, and our low-voltage business was flat in the quarter. We continue to see demand for our conduction system pacing offerings.

In the Q4, we began enrollment in the synchronicity trial, evaluating left-bundle branch pacing compared to conventional cardiac resynchronization therapy. So as we look to 2026, we anticipate that our growth will be closer to market in CRM over the course of the year, driven by the addition of our complementary bioenvelope and ongoing momentum within our diagnostics business. Our Watchman business delivered an outstanding 29% growth in the Q4 and on a full-year basis, exiting the year with strong double-digit growth across all major global markets.

We are extremely pleased with the performance of this franchise, with above-market growth driven by the strong adoption of concomitant procedures. We have now treated more than 25,000 patients concomitantly with Watchma. As we look ahead, we continue to invest in our portfolio of clinical evidence and driving efficiencies for physicians. In the quarter, we announced a strategic partnership with Siemens Healthineers to develop and commercialize their next-generation 4D ice catheter called Acunav, intended to offer physicians an innovative imaging option for standalone Watchmen or Feral Watch procedures.

And last month, we completed enrollment in the Simplify clinical trial, evaluating two single drug regimens as post-procedural alternatives to dual antiplatelet therapy, with data expected in the second half of 26. Importantly, our CHAMPION trial, a large randomized trial studying Watchmen Flex versus novel oral anticoagulation, was accepted and will be presented as a late breaker at ACC on Saturday, March 28th.

If positive this data would support Watchman as a first therapy for stroke prevention as an alternative to OEC and would expand the number of indicated patients from approximately 5 million today to 20 million globally We extremely proud of our global EP performance in the quarter with organic growth of 35% in the fourth quarter, resulting in 73% growth on a full-year basis.

As we enter our third year in the U. S. with our market-leading PFA technology, we believe that approximately 70% of AF ablations in the U. S. and 25% were done with PFA, with that number closer to 50% globally.

Within the quarter, global growth is driven by PFA catheter utilization supported by Opal placements and a scaled, high-performing commercial organization. We continue to invest in our ecosystem approach to innovation and recently received approval and limited market release in both Europe and the U. S. for a Fairpoint PFA catheter.

NAV enabled that can create focal lesions initially indicated for atrial flutter. We're also studying Ferapoint in the Rematch AF trial for use in redo procedures, with data expected in 2027. We're pleased to have initiated the optimized trial studying the Cortex OptiMap mapping technology with the Ferapulse PFA system, which is intended to address our unmet needs in identifying sources of AFib as an alternative to traditional anatomic approaches. a capability that may be particularly important to more complex patients.

As we look to 2026, we anticipate that the EPE market will grow approximately 15%, and we expect to outpace that market growth, led by our differentiated PFA portfolio, ongoing expansion and utilization of mapping systems, and continued adoption of PFA across the globe. Importantly, Boston Scientific is uniquely positioned with its leading AF Solutions portfolio and a commercial team in the value to physicians of patients with our concomitant FairWatch procedure, supporting operational efficiency and capacity.

So in closing, I'm extremely proud of our team and our performance in 2025, and we believe that our 26 guidance, along with our 26 to 28 goals of sales growing 10% plus, adjusted operating margin expansion of 150 basis points, and leveraged double-digit EPS growth continue to be highly differentiated. We have an incredibly strong global team that's focused on advancing science for patients globally while delivering differentiated results today, setting us up for a strong 2026 and beyond.

With that, I'll turn it over to John.

Thanks, Mike. Fourth quarter consolidated revenue of $5,286,000,000 represents 15.9% reported growth versus fourth quarter 2024. and includes a 160 basis point tailwind from foreign exchange, which was in line with our expectations. Excluding this $74 million foreign exchange tailwind, operational revenue growth was 14.3% in the quarter. Closed acquisitions contributed 160 basis points to sales, resulting in 12.7% organic revenue growth at the high end of our fourth quarter guidance range of 11% to 13%. Q4 2025 adjusted earnings per share of $0.80 grew 15% versus 2024, exceeding the high end of our guidance range of $0.77 to $0.79.

Outperformance was driven primarily by our favorable adjusted tax rate in the quarter. Full year 2025, consolidated revenue of $20,074 million represents 19.9% reported growth versus full year 2024 and includes a 70 basis point tailwind from foreign exchange. Excluding this $114 million tailwind from foreign exchange, operational revenue growth for the year was 19.2%. Closed acquisitions contributed 340 basis points to sales, resulting in 15.8% organic revenue growth, exceeding our full-year guidance of approximately 15.5%. Full year 2025 adjusted earnings per share of $3.06 grew 22% versus 2024, exceeding the high end of our guidance range of $3.02 to $3.04, and marking our third consecutive year of 20% plus adjusted earnings per share growth. Adjusted gross margin for the fourth quarter was 70.7%, resulting in full year 2025 adjusted gross margin of 70.6%, representing a 30 basis point expansion versus full year 2024.

In 2026, we anticipate full year adjusted gross margin to be roughly in line with full year 2025, as we expect favorable product mix to be largely offset by investments in our global supply chain and the annualization of tariffs. Fourth quarter adjusted operating margin was 27.3%, resulting in a full-year 2025 adjusted operating margin of 28.0%, improving 100 basis points versus full-year 2024.

In 2026, we expect to expand adjusted operating margin by 50 to 75 basis points, progressing toward our goal of 150 basis points of operating margin expansion over our long-range plan. On a gap basis, fourth quarter operating margin was 15.6%, resulting in a full-year reported operating margin of 18.0%. These results include a $194 million litigation charge relating to the full resolution of a legacy IP-related matter.

Moving to below the line, fourth quarter adjusted interest and other expenses totaled $99 million, resulting in full-year adjusted interest and other expenses of $430 million, slightly favorable to our expectations, primarily driven by higher interest income. On an adjusted basis, our tax rate for the fourth quarter was 10.7% and 11.7% for the full year, which was favorable to expectations and inclusive of favorable discrete tax items.

Our operational tax rate was 14.9% for the fourth quarter and 14.2% for the full year, in line with our expectations.

Fully diluted weighted average shares outstanding ended at 1,496,000,000 shares in the fourth quarter and 1,494,000,000 shares for full year 2025. Free cash flow for the fourth quarter was $1,013,000,000, with $1,364,000,000 from operating activities less $351,000,000 in net capital expenditures. Full year 2025, free cash flow of $3,659,000,000 exceeded our expectations, reflecting 38% growth versus 2024 and 80% free cash flow conversion. For 2026, we expect full-year free cash flow to be approximately $4.2 billion, and we continue to target free cash flow conversion in the range of 70% to 80% over the long-range plan.

As of December 31, 2025, we had cash on hand of $1,965,000, and our gross debt leverage ratio was 1.9 times. Following the announcement of our agreement to acquire Penumbra, all three major rating agencies affirmed our single A- equivalent credit rating. Additionally, Fitch Ratings upgraded our outlook from stable to positive.

Our capital allocation priority remains strategic tuck in M&A, followed by sherry purchases. In alignment with this strategy, we recently closed the acquisition of Nalu Medical, which is complementary to our neuromodulation pain franchise. Additionally, we announced agreements to acquire Valencia Technologies and Penumbra, which, upon close, will enable Boston Scientific to enter strategic adjacencies within our urology and cardiovascular businesses, respectively.

Our legal reserve was $242 million as of December 31st, with $46 million already funded through our qualified settlement funds. I'll now walk through guidance for Q1 and full year 2026. We expect first quarter 2026 reported revenue growth to be in a range of 10.5% to 12% versus first quarter 2025. Excluding an approximate 200 basis point tailwind from foreign exchange based on current rates, we expect first quarter 2026 operational and organic revenue growth to be in a range of 8.5% to 10%, which includes an approximate 150 basis point impact from the discontinuation of accurate and a transient impact associated with the product removal of certain sizes of our Axios device. We expect full year 2026 reported revenue growth to be in a range of 10.5% to 11.5% versus 2025, excluding an approximate 50 basis point tailwind from foreign exchange based on current rates, we expect full year 2026 operational and organic growth to be in a range of 10% to 11%.

We expect full year 2026 adjusted below the line expense to be approximately $440 million. Under current legislation, including enacted laws and issued guidance, we forecast a full year 2026 adjusted tax rate of approximately 12.5%. In Q1, we anticipate our adjusted tax rate will be approximately 12%. We expect full year 2026 adjusted earnings per share to be in a range of $3.43 to $3.49, representing growth of 12% to 14% versus 2025, including an approximate $0.03 headwind from foreign exchange. We expect first quarter adjusted earnings per share to be in a range of 78 cents to 80 cents.

In closing, I'm pleased with the strong financial performance our global team delivered in 2025, and we look forward to executing on our full year 2026 guidance of 10% to 11% organic revenue growth, 50 to 75 basis points of adjusted operating margin expansion, and 12% to 14% adjusted earnings per share growth. For more information, please check our Investor Relations website for fourth quarter 2025 financial and operational highlights, which outlines more details on fourth quarter results and our 2026 guidance.

And with that, Lauren, I'll turn it back to you to moderate the Q&A.

Thanks, John. Drew, let's open it up for questions for the next 35 minutes or so. In order for us to take as many questions as possible, please limit yourself to one question. Drew, please go ahead.

Well, thank you. Thank you, Rob. I'd be happy to. And I'll touch on your question. Overall, we're super pleased with the quarter and the full year, growing 16%. EPS growing 22% for the full year, and six of our business users growing faster than market, growing faster than the WAMGAR, and setting us up for strong guide and investments for the overall company.

The two businesses that you called out, I think you nailed it. If you look at EP, we're quite pleased. Actually, our results in Q4 exceeded our internal target, and Watchman withdrew 29%, pretty much similar to the third quarter, as we elapsed the anniversary of the concomitant reimbursement a year ago. You know, specific to EP, really pleased with the results of 35%.

Two of our larger competitors resulted at results of 6.5% growth, the market leader. third place player, 12.5%. We grew 35. So we continue to gain share overall. And to your point, we think the market in Q4 was closer to 18 to 20% growth rather than what some other companies have claimed at 25%. So we think the market was kind of 18 to 20% range, similar to what we developed internally in our plan. And we've called the market for 2026, about 15% growth. So we think it's an excellent market. We don think it grew 25 in fourth quarter We grew faster than our peer group based on this percentage that I saw or that we laid out We actually grew even faster outside the U than the U The U. S. is more highly penetrated with PFA.

There's actually more competitors present outside the U. S. and we've accelerated growth outside the U. S. So our PFA performance is quite strong. The market's still healthy. We think it's 18% to 20% in fourth quarter. and we exceeded our internal plan. We got new products approved. Our mapping footprint continues to grow. And we have a lot of clinical data that various clinical studies that are in flight. So we're very confident with our PFA business and our performance.

With Watchmen, we grew 29%. Excellent job. We pretty much are the market with Watchmen. Concomitant continues to grow. and we did annualize the concomitant reimbursement, which happened in fourth quarter last year. So we're quite proud of the 29%. You know, when you come to these consensus numbers, we exceeded our guidance. We actually exceeded analyst consensus. The mix of that is slightly different, but it shows the power of all of Boston Scientific, being able to deliver, to beat our guidance, to beat consensus in the quarter and the full year. And we're quite proud of the EP performance based on the commentary I just provided.

Yeah, well, again, look forward to presenting the results of Champion at ACC. We will be hosting an event for investors on that Saturday night at 5.30 p. m. Central Time. And, you know, we can get deep into the data at that point. Again, I think, you know, there are two co-primary endpoints, you know, one non-inferiority for combined endpoint stroke, systemic embolism and death, one for bleeding. And just as we saw with option, I think both of those are going to be important for the field.

In terms of the first half of your question, it can absolutely, again, you just saw the numbers we reported out. It can vary without any equivocation, say that we have not seen any impact from those trials, closure, alone AF and Ocean. And, again, we continue to see very robust uptake of watchmen in general and of concomitant procedures specifically.

I think we've been pretty consistent with our messaging on EP. We do think the market's 18 to 20, like we said. I think some maybe have overshot the market growth in Q4.

When you're the highest market share leader in PFA and competitors are coming out, we planned and we did expect to lose some share, given the competitive launches that are coming out given our really dominant market share position going into 2025. So we did anticipate that. And we're also very comfortable to say, as we looked at the end of 26, that we'll be the clear BFA market leader.

And we also think our EP business will grow faster than 15%. So with new interest coming, it's not surprising that we lost some share. But the overall EP growth of 35%, I think, is quite impressive, given the size of that business now. and grew faster overall than our competitors. On the first quarter guide, we guided full year to 10 to 11, which we think is strong guidance given where we are early in the year here. And 8.5% to 10%, simply two factors really. One is our toughest comp of the year. And secondly, we do have about 150 BIPs of impact from the accurate discontinuation along with the Axios withdrawal. Well, not full withdrawal, but partial matrix withdrawal, which will impact the first half of the year.

So we see both those products, both those issues will be addressed as you get into, call it June, for the second half of the year with the impact of Acura being gone, Axios being gone, our product launches, and slightly easier comps, although it's still tough, but slightly easier in the first quarter.

Sure. I guess, you know, as we exit 25, you know, we're kind of in a, what, our 65-ish percent PFA market share position. We have a market that we think is going to grow 15%. We have high utilization in the U. S. , call it 80%, 70%, 80%, and outside the U. S. , quite a bit lower. So with a healthy market, we expect to continue to grow above market.

Our PFA share will reduce somewhat, but we're very confident by year end. Likely, if you add all the other competitors together, our share will be equal to them or in that area. We're not going to break out share by quarter, but we're very confident that we'll maintain clear market leadership in PFA over the course of 2026 and beyond. And I think if you look at the drivers that continue the strong pace of growth overall, one, it's geographic scope. We continue to gain share in Japan. We just got a persistent indication.

We continue to drive more account openings, utilization in Japan. China is a very, very big market, a small part of our number. We made significant investments the past 18 months in China. and you'll see China have a more significant impact on our overall global growth. Europe's the most competitive market, but our growth rate's quite impressive there, and we just got approval for the Fairpoint catheter. In the U. S. , same thing. Our now more significant scaled mapping commercial team continues to gain experience, continues to add more mappers, more opal systems.

The Fairpoint product will allow us more time in the lab to expand our reach in different clinical indications. And we have a host of products in the pipeline. You mentioned a few of them. They won't impact 2026 in a meaningful way, but we continue to widen out the portfolio with our Cortex clinical trial work being done, the recent Fairpoint approval, and then we have a whole cadence of new catheters coming over the coming one to three years. So we have significant investments in the portfolio, and we continue to expect to be the clear market leader and have a very strong 26 growing faster in the market.

Yeah, great. I think, again, we expect to have a great year in EP and Watchmen. We've got Champion Trial coming out. Those results will be coming through. Concomitant is doing terrific. We're training more EP docs on Concomitant every day. As you said, broadly, the comps do get a little bit easier. We expect to have stronger performance in number of our business units in 26 versus what we had in 25. We do expect our PI business, our Euro business, our Neuromod business, and our CRM businesses to have stronger years in 26 than they did in 25.

Not many questions on Neuromod, but that business we expect to be a high performer in 26, along with improvement in PI, Euro, and CRM. And then you have our other businesses, which are performing quite well. As we get through this Axios issue, our endo business is strong. Our IO business has now scaled to over a billion dollars, growing nicely in the double digits.

Our coronary business grew 20% in the quarter, and now we're launching our seismic IVL and PI. And we just finished enrollment in our IVL platform for coronary. And importantly, we've also initiated our first clinical work with Vitalist and hypertension. So we have a number of investments that we're making for the long term, and it's really the whole of Boston Scientific.

And of our eight divisions, six of them grew faster than market, which is pretty consistent. We grow faster than Whamger. So we love our EP business. We love our Washington business, but it's the entire company that gives us confidence in the 10% to 11% guide for the full year.

Yeah, we do that every day at the company. I highlighted on Neuromod, a smaller business, but I think you'll see strong performance in 2026. We just added additional product in that category to be acquisition. Urology was a tougher year this year. We had some supply chain issues. Axonix integration didn't go as well as we wanted to initially with some commercial disruption, but we feel comfortable with that.

So also with new product launches coming to Urology, we expect Urology to be at minimum back-to-market growth with our Euro business, Neuromod quite a bit above growth. And Endo is really a solid, high-performing company with second-half launches that will be important for us once we get through that Axios issue. So a lot of confidence that med-surgents in general should have.

Ideally, we plan on a better year than 26, and 26 versus 25. And other businesses, you know, ICTX is a very large business with us now. Our complex coronary business grew 23%. I'm sorry, complex coronary grew 31% in the quarter, 23% for the year. And our ICTX business, despite the discontinuation of accurate, grew 10% in the quarter.

So that business is doing extremely well with agent, with our imaging portfolio, and we have the most product launches and biggest clinical studies in that business. So we continue to diversify and strengthen that ICTX business. that doing quite well Our interventional oncology business we have new product launches there We done a tuck in M So we continue to fuel all of our businesses We don invest at the same rate for all of them given the Watchman and EP growth profile But it's classic Boston Scientific doing organic R&D, tuck in M&A, to continue to grow above our weighted average market growth rate.

I'm not sure I quite get the question. I would say on the commercial side, we have tremendous scale in our EI business commercially and within our interventional cardiology business. We're combining the reporting structure of those business units together, so we're very much market leaders in that area. The announcement of Penumbra, as we talked about, is really exciting for us. It gets us into new high-growth markets in PE and neurovascular, just to name a few, with a highly scaled sales force. So in terms of commercial clinical capability, I think we're pretty unmatched in that area.

And traditionally with a company, you've seen a lot of organic R&D like Agent was, and a lot of clinical work with new products being introduced starting with IVL this year. And we'll continue to look at more tuck-in M&A there. So I think that whole, we call that ICVT area now, we're very bullish on, and some of the biggest investments in the company are in that area.

Yeah, Daniel, I mean, I think you nailed it, right? I mean, we've now anniversary, I mean, we're three years into the launch of Farapulse in the U. S. I think, you know, the efficiency gains that people saw, you know, are largely now built into the system. And, you know, I think as Mike said, you know, that's why what we're looking for, again, is 15% growth in the EP market next year. Again, we are growing and believe we will continue to grow faster than that market. But, you know, the keys, again, I feel a little sort of almost silly that I'm apologizing for 15% growth in, you know, what's one of the largest markets in MedTech.

But, you know, the keys to driving that forward will be, A, starting to build out of ASCs in the United States to unlock some more capacity and reduce those waiting lists, continued just development and repurposing cath labs for these 4-EP procedures in the hospital, continuing what we can do as a company to help further drive greater efficiency in procedures.

So things that we can do with concomitant procedures, just growth of concomitant overall helps with that efficiency. We've talked about some of the other investments that we've made, the partnership with Siemens for de-ICE. But really, until all of those things play out, that's why we really don't see growth exceeding 20% in the market and why that 15% seems to us to be a much more realistic way to view it. But again, to close, but it is our intent to continue to grow faster than that market.

Yeah, we'll get into it a little bit. It's a bit too early for that. We're excited about the Siemens collaboration. That's a product that's in development. It's not commercially available yet. So we, in partnership with them, it's really going to be different segments. That'll be very much a premium product and markets that can pay for premium product. And we think it'll be differentiated and further differentiate our Watchmen and Fairflex capability.

2D ICE would be a different price point. It's been an established market for a while. So our 2D ICE programs will really be just a nice portfolio addition to our overall portfolio within our EP portfolio bag.

Yeah, Matt. First of all, just to clarify, the bleeding endpoint is powered as a superiority endpoint. We'll see what it shows when we report it out. But the goal there would be to show superiority on bleeding complications. I think it'd be, you would have needed to power for superiority on stroke, would have needed a trial that would probably have been an order of magnitude larger.

And so that's part of, and I, well, just backtrack on that a little bit. And I don't think we need to show superiority on stroke. Again, the goal here would be to show that Watchmen would be non-inferior, so as effective as the drugs, but to be able to show superiority in bleeding. And again, that was what we demonstrated with option, and I think everyone's seen the impact that that's had for the option population. In terms of the second part of the question, I think it's a perceptive question because there are a couple of things that would happen if champion does turn out to be positive. All right. And one is developing the new indication, but the other is strengthening the current indication.

And so I do believe that a positive champion would give increased impetus for referrers to referring for the current indication, which includes the option indication. It will take time to build out the new indication, get better representation and guidelines, and get a revision of the CMS national coverage decision. And again, that's part of when we look at the champion story, right, if it's positive.

It's not just a step change in growth in Watchmen, but something that sustains the growth in Watchmen over our long-range plan. Absolutely.

Yeah, it hasn't changed. If we were doing our investor day today, we'd get the same numbers. 10% plus, 26 to 28, 150 bps of margin improvement, and a strong double GDPS growth, you know, even within that. And then we think Penumbra further enhances our WAMGAR and further strengthens the company beyond that. So really no change of position here.

Our whole key to our business is being in fast growth markets, which we've demonstrated. We anticipate in that time horizon that WAMGAR gets closer to nine. Penumbra actually could slightly even improve that. once that closes by a small margin, but slightly improve it. And exploding penumbra, we're very comfortable with those LRP goals, as we stated.

Yeah, thanks, Chris. Again, I think, first of all, right, 70% penetrated in AFib. There's still 30% left to penetrate. And, you know, there's always just a tailwind of adoption of new technologies.

I think as you look at arrhythmias other than HL fibrillation, you know, There is probably the two prime use cases where we would see a real advantage to moving to PFA would be for atrial tachycardias, you know, the atypical atrial flutter type thing. Although, frankly, we think that's going to be a diminishing part of the market going forward because usually where that's seen, that's a redo AF ablation. and we just see redo numbers shrinking with the efficacy of Ferrapulse for de novo ablation.

I think the other thing you hit on is ventricular tachycardia. We are already engaged in a couple of studies of using Ferrapulse technology for ablation in the ventricles, and it's one of the areas where both the Farah Point catheter and Farah Flex catheter, which is in development now, and I'm very pleased with the progress of that in its first human use studies.

But that is one of the areas, again, I think those catheters and those form factors are going to shine.

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