AngioDynamics capped fiscal 2026 with a quarter that crystallized a multi-year strategic pivot, delivering 8.0% pro forma revenue growth in Q4 and the seventh consecutive quarter of double-digit Med Tech expansion, alongside the company's first full year of positive adjusted EBITDA on a continuing-operations basis. The headline that matters, however, is not the top line. It is the composition. Med Tech now contributes 47% of total revenue versus roughly 25% when the transformation began in 2020, and within that segment, NanoKnife irreversible electroporation sales accelerated 64.5% in Q4 while Auryon atherectomy extended a 20-consecutive-quarter double-digit growth streak. The market is still pricing AngioDynamics as a struggling Med Device rollup with an 8% grower inside it. We read the latest print as evidence the wrapper is dissolving: the company is becoming a Med Tech platform with a Med Device tail, and at roughly $15.67 per share against $53.9 million in cash, a debt-free balance sheet, and fiscal 2027 guidance of 12% to 15% Med Tech growth, the equity is not yet paying for the mix shift that has already happened in the P&L.
The mechanism behind the re-rating, in our view, is reimbursement. Two pieces of policy have moved in the same direction inside a six-month window. Category I CPT codes for irreversible electroporation in prostate and liver went live on January 1, 2026, formalizing the procedure in the billing system. Then in May 2026, Palmetto GBA, one of the largest Medicare Administrative Contractors covering roughly 18 states, finalized a local coverage determination for NanoKnife in favorable intermediate-risk prostate cancer and metastatic colorectal cancer to the liver, effective July 5, 2026. Two-year PRESERVE pivotal data presented at the American Urological Association meeting in May confirmed 97% of patients with available follow-up had a PSA below baseline with no new device- or procedure-related adverse events between months 12 and 24. The clinical, coding, and coverage triangle is now closed in the United States for the two largest IRE indications, which is the gating event for procedure volume that the NanoKnife business has been waiting for since the FDA 510(k) clearance for prostate tissue ablation.
The single load-bearing risk is a guidance gap that the print did not close. Management guided fiscal 2027 net sales to $336 million to $341 million, a 4.9% to 6.4% pro forma growth range that is below the 9.4% delivered in fiscal 2026, because the easier Med Device tailwind is fading and Med Tech growth at the guided 12% to 15% does not yet fully offset it. The market can reasonably read that as either conservatism ahead of catalyst-rich quarters, or as a signal that Auryon is approaching its competitive ceiling in peripheral atherectomy and the next leg of Med Tech acceleration will need to come from NanoKnife alone. The falsifiable clock is the first fiscal 2028 quarter print, expected in early October 2026, which will reveal whether July's coverage effective date translated into a NanoKnife capital and probe order inflection. If Q1 FY2028 NanoKnife growth comes in below 50% year over year on a tough comparison, the Med Tech story re-rates down. If it prints above 80% with broad-based capital and probe gains, the equity is meaningfully cheap at the current multiple.