AngioDynamics (ANGO) Q4 2026 earnings review
Med Tech Mix Shifts Higher, But Profitability Breakout Stalls
AngioDynamics' fiscal 2026 closed with a solid 8.0% YoY pro forma revenue growth in Q4, validating management's strategic pivot toward high-growth Med Tech. The Med Tech segment surged 16.7%, heavily fueled by a massive 64.5% inflection in NanoKnife sales following the activation of its CPT 1 code. However, the top-line success is failing to translate into meaningful bottom-line leverage. Mechanical Thrombectomy unexpectedly stalled, declining 1.1% YoY in Q4 due to a steep drop in AngioVac. Furthermore, FY27 guidance projects adjusted EBITDA of $13.0-$16.0M, showing virtually no operating leverage over FY26's $13.2M result despite the margin-accretive shift to Med Tech.
🐂 Bull Case
The long-awaited CPT 1 code for prostate procedures is finally showing up in the numbers. NanoKnife revenue exploded 64.5% YoY in Q4, driven by 47% growth in probes and 132% growth in capital.
Auryon just delivered its 20th consecutive quarter of double-digit growth (+14.4% in Q4). The platform is proving resilient and continues to take share in the peripheral atherectomy market.
🐻 Bear Case
Previously hailed as the fastest-growing portfolio, MT sales actually contracted 1.1% in Q4. A 38.4% gain in AlphaVac was completely wiped out by a 15.8% collapse in AngioVac.
Despite a continued mix shift to higher-margin Med Tech and $15M in planned manufacturing transition savings, FY27 EBITDA guidance ($14.5M midpoint) represents negligible growth over FY26 ($13.2M), suggesting heavy ongoing cash burn on operations.
⚖️ Verdict: ⚪
Neutral. The Med Tech transformation is real, and NanoKnife's breakout is a massive win. However, AngioVac's deterioration and the lack of forecasted EBITDA expansion in FY27 restrict near-term upside.
Key Themes
NanoKnife Adoption Accelerating Post-Reimbursement
The January 1 activation of the Category I CPT code for NanoKnife prostate procedures is delivering immediate dividends. After posting 26.7% and 22.2% growth in Q1 and Q2 respectively, Q4 growth rocketed to 64.5%. Crucially, capital sales grew 132.5%, indicating that new centers are buying the hardware to build out prostate ablation programs, while a 47.0% increase in probes confirms utilization is expanding rapidly.
Mechanical Thrombectomy Hits a Wall
A severe contradiction to management's historical narrative has emerged. In late FY25 and early FY26, MT was touted as the 'fastest-growing part of the business' (+41.2% in 26Q1). In Q4, the total MT segment reversed into a 1.1% YoY decline. While AlphaVac grew a respectable 38.4%, it was entirely negated by AngioVac plunging 15.8%. Management must address whether AngioVac is losing market share to competitors or suffering from sales force cannibalization as reps prioritize AlphaVac.
Auryon's Unbroken Durability
Auryon delivered its 20th consecutive quarter of double-digit growth, posting a 14.4% YoY increase in Q4 to $17.8 million. This consistency points to successful execution of the strategy to shift sales from Office-Based Labs (OBLs) into higher-margin, stickier hospital settings.
Profitability Stagnation Despite Mix Shift
Med Tech revenues climbed to 47% of total sales in FY26 (up from 43% in FY25), which historically drove gross margin expansion. Yet, FY27 Gross Margin guidance of 54-55% implies flat to declining margins compared to FY26 actuals (54.6%). Management appears to be reinvesting all gross profit gains back into SG&A and R&D, delaying the timeline for the company to achieve meaningful GAAP profitability.
Tariffs Are a Permanent Base Cost
The macroeconomic headwind of tariffs has transitioned from a temporary shock to a structural drag. Tariffs shaved 151 basis points off FY26 gross margins, totaling $4.8 million in expense. Management guided that the tariff impact in FY27 will be 'broadly similar,' forcing the company to rely entirely on manufacturing footprint shifts (like the Costa Rica move) to defend margins.
Pipeline Expansion: RELIEF Study and AlphaReturn
The product pipeline is expanding total addressable markets (TAM). The newly approved RELIEF study tests NanoKnife for Benign Prostatic Hyperplasia (BPH)—a dramatically larger patient population than intermediate-risk prostate cancer. Simultaneously, the FDA IDE approval for the APEX-Return study allows AngioDynamics to evaluate AlphaReturn, a closed-loop system addressing blood loss concerns during thrombectomy, effectively eliminating a key barrier to surgeon adoption.
Other KPIs
Reversing the severe cash burn of the past. Q4 alone generated $17.5 million in cash from operations, bailing out the negative cash flows of the first half of the year and allowing the company to end the year with $53.9 million in cash and a debt-free balance sheet.
Stable. Up 70 basis points YoY despite absorbing a 151-basis point drag from tariffs. The improvement was driven entirely by favorable pricing and the continued mix shift toward higher-margin Med Tech products.
Guidance
Stable. The midpoint of $338.5M implies a 5.7% YoY growth rate. This represents a deceleration from the 9.4% pro forma growth achieved in FY26, largely due to tougher comps and a flat Med Device business.
Decelerating. A step down from the 18.4% growth achieved in FY26. Given NanoKnife's acceleration, this implies management expects Auryon or Mechanical Thrombectomy growth to moderate significantly in the coming year.
Stable. The $14.5M midpoint represents meager ~10% growth over the $13.2M delivered in FY26. It indicates that structural profitability is capped for another 12 months as the company absorbs ongoing tariff costs and funds commercial expansion.
Key Questions
AngioVac Reversal
AngioVac sales declined 15.8% YoY this quarter, driving the total Mechanical Thrombectomy portfolio to negative growth. Is this a permanent structural loss to competitors, or a temporary disruption due to cannibalization from AlphaVac?
EBITDA Leverage Ceiling
Med Tech is growing double digits and the Costa Rica transition is complete, yet FY27 Adjusted EBITDA guidance implies almost zero operating leverage. When will the mix shift translate to meaningful bottom-line expansion?
NanoKnife Capital vs Disposable Pull-Through
NanoKnife capital sales grew a massive 132.5% in Q4. What is the expected lag time before these new placements reach steady-state procedure volumes and probe utilization?
BPH TAM and Commercialization
With the RELIEF study for BPH now FDA IDE approved, what is the timeline to potential commercialization, and how does the margin profile for BPH procedures compare to oncology?