Inari Medical (NARI) Revisit

NARI posted excellent numbers at its most recent earnings release. If NARi were an SaaS stock, we’d all be drooling. It’s not, but there are some persuasive reasons to consider it. The stock has exceptional gross margins, terrific revenue gain, recent increase revision of its TAM – and it’s profitable. First, let’s look at the numbers and then get into some of the highlights of the conference call.

	       Q4	Q3	Q2	Q1'21	Q4	 TTM 																																	
Revenue	       83.2	72.9	63.0	57.0	48.6     277																																			
seq chg	       14.1%	15.7%	10.5%	17.3%																																					
yoy chg	       71%	88%	63%																																						
Patients       7,700	6,696																																							
seq chg	       15.0%																																								
Gross mar .    90.1%	90%	92%	92%	92.4%																																				
Net Inc. M     1.1 	-2.8	4	8	7																																				
Cash*          180	169	176	174																																					

*The cash figure was at the time of the earnings release. Since then, Inari issued 2.3 million shares for a net of $151.5 M so the cash should now be about $331.5M.

According to Form 8-K, March 10, 2022:
“The Company estimates that the net proceeds from the Offering were approximately $151.5 million, after deducting underwriting discounts and commissions and estimated offering expenses payable by the Company. The Company currently intends to use the net proceeds from the Offering to fund product development, research activities and clinical development activities, to expand its commercial activities in the United States and internationally, including marketing personnel and programs, and the remainder for working capital and other general corporate purposes.”…

Q4 2021 Results - Earnings Call Transcript
Based upon this work, we believe these markets to be meaningfully larger than we’ve communicated in the past. We now believe the total annual incidence of patients diagnosed with intermediate to high risk PE in the U.S., using the same definition we’ve always used, is 280,000 patients, compared to our previous TAM estimate of 200,000 patients. Similarly, we now believe the total annual incidence of patients diagnosed with iliofemoral DVT, again, using the same historical definition is 430,000 patients, up from 262,000 patients in our previous DVT estimates. Combined, this represents 710,000 total addressable VTE patients in the U.S. and with our historical average selling price. The total new TAM is $5.8 billion. This is 53% larger than our previous TAM estimate of $3.8 billion.
Based on these new TAM estimates, we believe, in 2021, only about 4% of all the patients who could benefit from our devices were actually treated. In addition to better understanding our TAMs, we completed similar work to understand the total number of hospitals with cath labs in interventional suites.
Sales organization. We ended 2021 with just over 200 territories, slightly above the range to which we guided earlier in the year. We expect to add territories in 2022 at roughly the same cadence we’ve demonstrated in the past and finish the year with at least 275 territories.
Our second growth driver is building awareness and driving deeper adoption at existing hospital customers. Most VTE patients continue to be treated with anticoagulation alone and in fact, a large percentage of these patients never even see a physician with a VTE expert. We continue to drive awareness of the benefits on our procedures with non-interventional physicians and we continue to work with hospital administrators to install more systematic processes to consistently identify and triage VTE patients to the physicians who best understand the disease state.

The company is not founder-led. Donald Milder has served as a member of our board of directors since September 2011 and as its Chair since December 2019. He is the largest shareholder with 7.4% of shares outstanding. CEO William Hoffman is the owner of 0.8% of the company’s shares.….

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I was thinking about NARI too. A few docs said that they couldn’t see continued growth from NARI. If my memory serves me right, I think that they felt that the Inari’s website overstated the benefits, and that research hospitals might initially buy the Clottriever, but they couldn’t see much potential past that.

I discussed two medical device technology companies on this board: Shockwave and Inari. Docs on TMF boards were pretty down on both, but both stocks have done OK. They certainly haven’t matched DDOG, but I think Inari might be worth a look. There’s a lot of people that would benefit from this technology, and there has to be some reason for the continued growth. If they do have the best, most cost effective solution, they would certainly have the demographics of an aging, overweight population pushing the utilization of NARI’s devices and a long runway for growth. Maybe there’s some truth to Inari’s claims after all.



bulwnkl, you may be referring to jonwayne’s post #80865. While pointing out he is an internist and not a cardiologist, he expounds at length why choosing medical device companies involves way too much onion layer peeling.

You also mentioned Shockwave; and there’s another company, Boston Scientific, which has a device called Ekos for pulmonary embolism clot removal. EKOS uses ultrasound technology to unwind and thin fibrin strands to expose more drug receptor sites; acoustic streaming drives the drug deeper into the clot.

So it seems to me that these companies don’t have a moat. When Saul first wrote up Inari in post 75175, he said: Another problem I see is that there is no moat except that it works, and if another company came out with either a better product, or with an equal product at a significant cheaper price, the doctors could possibly change device companies tomorrow and not miss a beat. However doctors are pretty conservative, and if they have a procedure that they have learned to use, and that they know works well, and works safely, they are probably very unlikely to change unless there is a CLEAR advantage.

NARI’S growth rate and gross margins are quite good, but other concerns might mean it’s not worthy of a big commitment.

By the way, the company in its earnings call transcript that Q1’s number may be on that weak side; but they see a 30% revenue increase for the full year over TTM.

Well the thrombectomy market is heating up! Really big competition is coming for INARI:……

It looks like that the Market / TAM is big and there is enough room for more then one player!

But its funny that all SaaS / Hypergrowth stocks are 50-80% off there highs and INARI is holding very well and just 30% from ATH away.

Some info…….……

I am a pulmonologist and sleep doc but have no personal experience in invasive procedures

I’m an interventional radiologist and use the Inari device regularly. I also have a lot of experience with the other thrombectomy devices ie Jeti, the penumbra, EKOS etc. The inari device is great because it’s easy to use and works well. We who do these thrombectomy procedures have been waiting for a device that works well enough that we can avoid using Tpa, which is a medicine that you drip through the EKOS catheter over a number of hours to break up blood clots. Tpa, however, has a significant bleeding risk and requires patients to be in the ICU while it is being infused. I rarely use EKOS anymore. The issue with Inari is that the TAM i can’t imagine is that big. Of course there are lot of people with DVT and PE, but only a fraction of those require intervention. The vast majority will do fine on the standard of care which is an injectable or oral blood thinner. Inari will need to really branch out and create devices for other pathologies if they are going to grow at any sort of pace. As mentioned above, there are several other thrombectomy devices that are about to hit the market as well.


HyperG, I know your post is greatly appreciated by anyone interested in Inari. That is the strength of this board. The company was brought to the attention of this board by wakeboarderHD and then picked up by Saul a few months later. Now from you we have have a good look at this company by somebody who uses its products and knows the field.

It behooves all of us to keep our eyes on the prize; namely, bringing to the board’s attention companies that may have potential and looking at the companies discussed in-depth.

In these difficult times it is not easy to stay focused. But if we pay attention to what’s important rather than taking potshots at one another, we will prosper more and feel better about each other