InspireMD's U.S. Revenue Line Reads $(351,000). The Parentheses Are Doing Real Work.

by Henry Nakamura · August 17, 2026

Earnings Reporter, Earnings Dispatch

InspireMD, the maker of the CGuard carotid stent system, released its second-quarter 2026 results on Monday, Aug. 17, from a Miami dateline. Most of the release looks like an ordinary micro-cap medical device quarter: revenue roughly flat against the year-ago period, total operating expenses up 2.5%, a net loss of $14.3 million. Then the geographic breakout arrives — not as a table, but as two sentences of prose in the financial results section — and the U.S. revenue figure for the three months ended June 30, 2026 is printed as $(351,000). The parentheses are not a typesetting accident. The company says so itself, in the very next sentence: "Net U.S. revenue was negative for the quarter."

The release explains why in its own words, and the explanation runs to a single sentence: net U.S. revenue was negative, "reflecting $734,000 of customer credits issued in connection with the voluntary recall of the CGuard Prime 135 cm delivery system, which exceeded gross U.S. product sales prior to the initiation of the recall." That causal link is the company's, not this publication's inference — InspireMD names the credits, names the recall, and states that the credits exceeded the quarter's gross U.S. sales. The credits were recorded against revenue rather than in cost of sales, which is what makes a revenue line capable of falling below zero at all: a revenue account can only go negative when credits, returns or reversals recognised in a period exceed the gross sales booked in that same period, which is precisely the mechanism the company describes. Nothing about the presentation is irregular. It is what the revenue-recognition rules require when a company hands back consideration it had previously recognised, and InspireMD has put it in the plain text of the release rather than leaving it to be reconstructed from a filing.

The size of the swing is recoverable from numbers in the same release. U.S. revenue for the six months ended June 30, 2026 was $827,000; U.S. revenue for the second quarter alone was $(351,000). Subtracting one from the other leaves roughly $1,178,000 of U.S. revenue in the first quarter of 2026. That is our arithmetic rather than the company's — the release does not print a first-quarter figure — but it follows directly from two numbers that it does print. On that basis the American business went from about $1.2 million of quarterly revenue to negative $351,000 in three months, a swing of roughly $1.5 million at a company whose entire consolidated quarterly top line is under $2 million. One piece of context cuts the other way, and the release supplies it: U.S. revenue in the second quarter of 2025 was $27,000. The domestic line that went negative was a controlled launch that had only recently begun producing meaningful revenue, not a long-established business.

Consolidated revenue, meanwhile, barely moved. InspireMD reported $1,771,000 for the second quarter of 2026 against $1,778,000 a year earlier — down $7,000, which the release itself puts at 0.4%. That flatness is the product of two opposite moves cancelling. International revenue was $2,122,000 in the quarter, an increase the release describes as 21%, against $1,751,000 a year earlier, while the domestic line went below zero. For the six months, international revenue was $4,342,000, which the company calls a 33% year-over-year increase. A reader who stopped at the consolidated revenue line would conclude that essentially nothing happened this quarter. The geographic split says two very different things happened and happened to net out.

The same collision shows up one line lower. Cost of revenues was $2,545,000 in the second quarter of 2026 against $1,465,000 a year earlier, an increase of about 74% on revenue that did not grow. The release reports the result as a gross loss of $774,000, against gross profit of $313,000 in the year-ago quarter. For the six months, the gross loss was $87,000 against gross profit of $605,000, even though six-month revenue rose from $3,307,000 to $5,169,000, a gain the release puts at 56.3%. Worth noting for what follows: the release prints margin percentages for the 2025 periods only — 17.6% of revenue for the quarter, 18.3% for the half — and no percentage-of-revenue figure for either 2026 period.

InspireMD does publish a bridge from that negative number to a positive one, and the bridge is worth reading literally. The reconciliation table carries four row labels — "Gross profit," "Inventory impairment," "Customer credits," "Adjusted gross profit" — across columns for the three and six months ended June 30, 2026 and 2025. For the second quarter it adds $612,000 of inventory impairment and the $734,000 of customer credits to the negative $774,000 of gross profit, arriving at adjusted gross profit of $572,000. For the six months the same two adjustments are $1,085,000 and $734,000, producing adjusted gross profit of $1,732,000. It ties to the dollar in both periods, which is not a discovery: adjusted gross profit is defined as gross profit plus those two add-backs, so the reconciliation is an identity and could not have come out any other way. What the table does yield is a number the release never prints. Because the customer-credit adjustment is identical in the quarter and the half, the entire credit fell in the June quarter; the inventory impairment, by subtraction, was about $473,000 in the first quarter and $612,000 in the second.

What the table does not contain is an adjusted revenue line or an adjusted gross margin line, and on a full read of the release no adjusted margin percentage appears anywhere in it. That omission is the part a reader has to handle carefully. The $734,000 of credits was deducted from revenue. Adding it back to gross profit without also adding it back to revenue leaves a numerator that has been cleaned and a denominator that has not. Set the $572,000 of adjusted gross profit against the $1,771,000 of reported revenue and the implied margin is about 32.3%; set it against a like-for-like revenue base of $2,505,000 that also excludes the credits and the implied margin is about 22.8%. Both of those are our calculations. InspireMD publishes neither, and it has not asserted either one — the caution here is aimed at readers and aggregators who might compute an adjusted margin from this release, not at the company, which did not compute one. Anyone who does should say which denominator they used, because the two answers are nearly ten percentage points apart.

The denominator problem repeats, in a much more consequential form, at the bottom of the income statement. InspireMD's net loss for the second quarter of 2026 was $14,324,000, larger than the $13,151,000 loss it recorded in the second quarter of 2025 — a deterioration of about 8.9%. Loss per share, basic and diluted, was $(0.17) against $(0.26) a year earlier. The loss got bigger and the loss per share got smaller, and the reason for that reversal in direction is the share count: weighted average shares outstanding were 84,659,943 in the quarter, against 51,003,900 a year ago, an increase of about 66%.

Run this quarter's loss over last year's share count and the arithmetic flips. A $14,324,000 loss spread across 51,003,900 shares is about $(0.28) per share, three cents worse than the $(0.26) InspireMD reported for the second quarter of 2025 rather than nine cents better than it. The six-month figures behave the same way: a net loss of $28,013,000 against $24,317,000 a year earlier, about 15% worse, reported as $(0.33) per share against $(0.48); measured on the year-ago weighted average of 50,508,660 shares, the 2026 half-year loss would be roughly $(0.55). Both of those constant-share-count figures are ours, not the company's — InspireMD does not publish them and does not claim them. Nor is any of the input hidden: the net losses, the per-share figures and both weighted-average share counts all sit in the release's own tables. But the headline per-share line points the opposite direction from the loss it is derived from.

The recall that generated the credits is itself a filed document. In a press release dated May 1, 2026, furnished to the SEC as an exhibit, InspireMD said it was initiating a voluntary U.S. recall of the CGuard Prime 135 cm carotid stent delivery system, having found that the controlled U.S. launch of CGuard Prime "has revealed opportunities to improve the technical performance," and that it had "taken the proactive step to pause commercialization" to implement enhancements. The scope stated in that release is narrow in three specific ways: it is a U.S. recall, it pertains specifically to the 135 cm delivery system, and it expressly "does not include the CGuard stent implant." The company said in the same release that the technical performance of the 80 cm version "meets all technical expectations."

That May 1 release also withdrew InspireMD's prior full-year 2026 revenue guidance, citing the impact of the temporary discontinuation of commercial activity in the U.S. pending anticipated FDA approval of its original CGuard stent delivery system. Monday's second-quarter release does not put that guidance back. Read in full, it contains no 2026 revenue outlook of any kind — no range, no reaffirmation, no replacement framework; the words "guidance" and "outlook" do not appear in it. Its forward-looking content is regulatory and operational, with one cost figure and no revenue figure. Chief executive Marvin Slosman said in the release, "We continue to engage in a productive dialogue with FDA regarding our pending regulatory submissions for our CGuard Prime 80 cm implant for TCAR procedures, as well as our original CGuard platform for traditional carotid stenting procedures. We continue to anticipate FDA decisions on both products later this year." In a separate passage he said the design improvements to the recalled 135 cm delivery system "are progressing as planned, with an FDA submission anticipated before year-end," and that, subject to the necessary approvals, the company expects to return to the U.S. market with both TCAR and CAS delivery systems.

The release also reports progress that a reader working only from the revenue line would miss. InspireMD said it commenced patient enrollment in CGUARDIANS III, the pivotal trial of its SwitchGuard neuroprotection system used with the CGuard Prime 80 cm stent in TCAR procedures, and reported 30-day outcomes from CGUARDIANS II in which, by the company's account, device success was achieved in all 50 patients with no deaths, strokes or myocardial infarctions and no stent thrombosis. It also named a senior vice president of global sales and marketing to support the anticipated U.S. re-launch. None of that attaches to a dollar figure in this quarter's statements, and it is reported here as the company reported it.

The one forward dollar figure in Monday's release is a cost number, not a revenue number. The company says that following the end of the second quarter it initiated savings actions designed to reduce its cost structure, improve operational efficiency and better align its resources with its strategic priorities, and that those actions are expected to generate annual savings of approximately $9 million. Because the actions came after June 30, none of that shows up in the quarter just reported: second-quarter total operating expenses were $13,671,000, an increase of $339,000, or 2.5%, from $13,332,000 a year earlier. The mix moved more than the total. Research and development rose to $4,295,000 from $3,834,000 and selling and marketing to $5,221,000 from $4,172,000, while general and administrative fell to $4,155,000 from $5,326,000. The company attributes the net increase to headcount-related expenses for the U.S. commercial team and to development, clinical and regulatory spending on SwitchGuard NPS and CGuard Prime 80 cm, partially offset by lower general and administrative compensation.

The balance sheet sets those savings against the resources on hand. At June 30, 2026 InspireMD held $15,149,000 of cash and equivalents plus $15,272,000 of marketable securities, roughly $30.4 million of liquid assets combined. At Dec. 31, 2025 the same two lines were $8,939,000 and $45,272,000, roughly $54.2 million. Cash itself rose over the six months; the combined figure fell about $23.8 million, because marketable securities fell $30.0 million. Total equity moved from $55,201,000 at year-end to $31,511,000 at June 30, and total assets from $69,404,000 to $44,641,000. The release makes no going-concern or liquidity assertion, and none should be read into these figures here; they are set out because they are the resources against which the $9 million of annual savings and the timing of any U.S. return will be measured.

For holders of the Nasdaq-quoted shares, the checkable items from here are narrow and dated. Whether the U.S. revenue line returns to positive territory in the third quarter depends on whether further credits are issued and on when American commercial activity resumes. Whether the adjusted gross profit bridge shrinks depends on the inventory impairment line, which on the release's own six-month and three-month figures implies $473,000 in the first quarter and $612,000 in the second. And whether the per-share loss keeps improving while the dollar loss widens depends on a share count that has already grown two-thirds in twelve months. The second-quarter release answers none of those; it does, to its credit, publish every number needed to ask them.