Catheter Precision (VTAK) 10-Q 12 May 21 2021 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2021	May 10, 2021
Cover [Abstract]
Entity Registrant Name	Ra Medical Systems, Inc.
Entity Central Index Key	0001716621
Document Type	10-Q
Document Period End Date	Mar. 31, 2021
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Title of 12(b) Security	Common Stock, par value $0.0001 per share
Trading Symbol	RMED
Security Exchange Name	NYSEAMER
Entity Filer Category	Non-accelerated Filer
Entity Common Stock, Shares Outstanding		3,256,314
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Entity Emerging Growth Company	true
Entity Small Business	true
Entity Ex transition period	false
Entity Current Reporting Status	Yes
Entity Shell Company	false
Entity File Number	001-38677
Entity Tax Identification Number	38-3661826
Entity Address, Address Line One	2070 Las Palmas Drive
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92011
City Area Code	760
Local Phone Number	804-1648
Document Quarterly Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	DE
Entity Interactive Data Current	Yes

Condensed Balance Sheets (Unaud

Condensed Balance Sheets (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Current Assets
Cash and cash equivalents	$ 15,954	$ 23,906
Accounts receivable, net	160	238
Inventories	2,249	2,218
Prepaid expenses and other current assets	1,555	1,258
Total current assets	19,918	27,620
Property and equipment, net	2,820	3,211
Operating lease right-of-use-assets	2,393	2,484
Other non-current assets	131	123
TOTAL ASSETS	25,262	33,438
Current Liabilities
Accounts payable	977	571
Accrued expenses	2,213	4,348
Current portion of deferred revenue	1,777	1,801
Current portion of equipment financing		265
Current portion of promissory note	674	421
Current portion of operating lease liabilities	338	356
Total current liabilities	5,979	7,762
Deferred revenue	617	686
Promissory note	1,326	1,579
Operating lease liabilities	2,195	2,264
Total liabilities	10,117	12,291
Commitments and contingencies (Note 13)
Stockholders’ Equity
Preferred stock, $0.0001 par value, 10,000,000 authorized none issued
Common stock, $0.0001 par value, 300,000,000 shares authorized; 3,259,340 and 3,188,679 issued and outstanding at March 31, 2021 and December 31, 2020, respectively	7	7
Additional paid-in capital	175,576	174,342
Accumulated deficit	(160,438)	(153,202)
Total stockholders’ equity	15,145	21,147
TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY	$ 25,262	$ 33,438

Condensed Balance Sheets (Una_2

Condensed Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Mar. 31, 2021	Dec. 31, 2020
Statement Of Financial Position [Abstract]
Preferred stock, par value	$ 0.0001	$ 0.0001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Common stock, par value	$ 0.0001	$ 0.0001
Common stock, shares authorized	300,000,000	300,000,000
Common stock, shares issued	3,259,340	3,188,679
Common stock, shares outstanding	3,259,340	3,188,679

Condensed Statements of Operati

Condensed Statements of Operations (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Net revenue
Total net revenue	$ 1,118	$ 1,374
Cost of revenue
Total cost of revenue	1,373	1,584
Gross loss	(255)	(210)
Operating expenses
Selling, general and administrative	4,114	6,285
Research and development	2,816	1,295
Total operating expenses	6,930	7,580
Operating loss	(7,185)	(7,790)
Other income (expense), net
Interest income	1	114
Interest expense	(52)	(25)
Total other income (expense), net	(51)	89
Loss before income tax expense	(7,236)	(7,701)
Net loss	$ (7,236)	$ (7,701)
Basic and diluted net loss per share	$ (2.48)	$ (13.98)
Basic and diluted weighted average common shares outstanding	2,917	551
Product Sales [Member]
Net revenue
Total net revenue	$ 406	$ 586
Cost of revenue
Total cost of revenue	790	964
Service and Other [Member]
Net revenue
Total net revenue	712	788
Cost of revenue
Total cost of revenue	$ 583	$ 620

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Statement Of Income And Comprehensive Income [Abstract]
Net loss	$ (7,236)	$ (7,701)
Other comprehensive loss:
Unrealized losses related to short-term investments		(22)
Total other comprehensive loss		(22)
Comprehensive loss	$ (7,236)	$ (7,723)

Condensed Statements of Cash Fl

Condensed Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
CASH FLOWS FROM OPERATING ACTIVITIES:
Net loss	$ (7,236)	$ (7,701)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	455	578
Provision for doubtful accounts		15
Stock-based compensation	1,169	1,047
Gain on sale of property and equipment	(501)
Changes in operating assets and liabilities:
Accounts receivable	78	87
Inventories	(14)	(98)
Prepaid expenses and other assets	(83)	57
Accounts payable	406	(176)
Accrued expenses	(2,172)	(560)
Deferred revenue	(93)	(215)
Other liabilities	(87)	(77)
Net cash used in operating activities	(8,078)	(7,043)	$ (28,300)
CASH FLOWS FROM INVESTING ACTIVITIES:
Proceeds from maturities of available-for-sale securities		11,000
Proceeds from sale of property and equipment	309
Purchases of property and equipment	(20)	(28)
Net cash provided by investing activities	289	10,972
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock, net of placement agent fees of $9	291
Payments on equipment financing	(265)	(76)
Payments of offering costs	(189)
Net cash used in financing activities	(163)	(76)
NET CHANGE IN CASH AND CASH EQUIVALENTS	(7,952)	3,853
CASH AND CASH EQUIVALENTS, beginning of period	23,906	14,584	14,584
CASH AND CASH EQUIVALENTS, end of period	15,954	18,437	$ 23,906
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES:
Receivable from sale of property and equipment	222
Unpaid offering costs	37
Transfer from inventories to property and equipment for lasers	17	102
SUPPLEMENTAL CASH FLOW INFORMATION:
Cash payments for interest	$ 2	$ 9

Condensed Statements of Cash _2

Condensed Statements of Cash Flows (Unaudited) (Parenthetical) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)
Statement Of Cash Flows [Abstract]
Underwriters' discount	$ 9

Condensed Statements of Stockho

Condensed Statements of Stockholders' Equity (Unaudited) - USD ($)	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit
Balances at Dec. 31, 2019	$ 33,150,000	$ 1,000	$ 150,280,000	$ 26,000	$ (117,157,000)
Balance (in shares) at Dec. 31, 2019		551,000
Common stock issued (in shares)		5,000
Stock-based compensation	1,047,000		1,047,000
Other comprehensive loss	(22,000)			(22,000)
Net loss	(7,701,000)				(7,701,000)
Balances at Mar. 31, 2020	26,474,000	$ 1,000	151,327,000	$ 4,000	(124,858,000)
Balance (in shares) at Mar. 31, 2020		556,000
Balances at Dec. 31, 2020	21,147,000	$ 7,000	174,342,000		(153,202,000)
Balance (in shares) at Dec. 31, 2020		3,189,000
Common stock issued, net	65,000		65,000
Common stock issued (in shares)		35
Stock-based compensation	1,169,000	$ 35,000	1,169,000
Net loss	(7,236,000)				(7,236,000)
Balances at Mar. 31, 2021	$ 15,145,000	$ 7,000	$ 175,576,000		$ (160,438,000)
Balance (in shares) at Mar. 31, 2021		3,259,000

Organization and Nature of Oper

Organization and Nature of Operations	3 Months Ended
	Mar. 31, 2021
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Organization and Nature of Operations	Note 1—Organization and Nature of Operations Ra Medical Systems, Inc. (the “Company”) was formed in September 4, 2002, in the state of California and reincorporated in Delaware on July 14, 2018. The Company is a medical device company that develops and manufactures advanced excimer laser systems for use in the treatment of vascular and dermatological diseases. The Company’s product development centers around proprietary applications of its advanced excimer laser technology for use as a tool in the treatment of peripheral artery disease (“PAD”) and psoriasis, vitiligo, atopic dermatitis and leukoderma. Reincorporation —In July 2018, the Company reincorporated in Delaware, the par value of each share of common stock was established to be $0.0001 and the number of authorized shares of common stock was increased from 10,000,000 to 25,000,000. In connection with the reincorporation, common stock and additional paid-in capital amounts in these financial statements have been adjusted to reflect the par value of common stock. All share information included in these financial statements has been adjusted to reflect this reincorporation. Initial Public Offering — On October 1, 2018, the Company closed its initial public offering ("IPO"). The Company’s registration statement on Form S-1 relating to its IPO was declared effective by the Securities and Exchange Commission on September 26, 2018. In October 2018, the Company filed an Amended and Restated Certificate of Incorporation which authorizes the issuance of 300,000,000 shares of common stock with a par value of $0.0001 and 10,000,000 shares of preferred stock with a par value of $0.0001. Reverse Stock Split — On November 16, 2020, the Company filed a certificate of amendment to the Certificate of Incorporation with the Secretary of State of the State of Delaware to effect a reverse stock split of the Company’s common stock at a ratio of one-for-twenty-five (“Reverse Stock Split”). The Reverse Stock Split became effective as of 4:01 p.m. Eastern time on November 16, 2020, and the Company’s common stock began trading on the New York Stock Exchange (“NYSE”) on a post-split basis on November 17, 2020. Unless otherwise noted, all share and per share numbers contained in in these financial statements are reflected on a post-split basis. COVID-19 — The global spread of the novel coronavirus (COVID-19) has created significant volatility, uncertainty and economic disruption. The ultimate effects of the COVID-19 on the Company’s business, operations and financial condition are unknown at this time. In the near term, the Company expects that its revenue will continue to be adversely impacted and enrollment in its atherectomy clinical trial will continue to be delayed or slowed, as patients elect to postpone voluntary treatments and many physicians’ offices have been either closed or operating at a reduced capacity. In addition, some customers are requesting more flexible payment terms on a temporary basis. The Company’s manufacturing facility located in Carlsbad, California is currently operational. Employee travel is limited to essential travel only and many employees are working from home when feasible. The Company has experienced minor delays in receiving shipments of parts, which has not had a material impact on the timing of its key engineering efforts, nor ability to support its atherectomy indication clinical trial. However, the extent to which COVID-19 impacts its business will depend on future developments, which are highly uncertain and cannot be predicted, including new information which may emerge concerning the severity of COVID-19 and the actions to contain it or treat its impact, among others. Going Concern —The Company has experienced recurring net losses from operations and negative cash flows from operating activities, has a significant accumulated deficit and expects to continue to incur net losses into the foreseeable future. The Company had an accumulated deficit of $160.4 million at March 31, 2021. In 2020, the Company used $28.3 million in cash for operating activities. As of March 31, 2021, the Company had cash and cash equivalents of $16.0 million. Management expects operating losses and negative cash flows to continue for the foreseeable future with the Company’s reduced commercial footprint, and as the Company continues to incur costs related to its atherectomy clinical trial, engineering efforts to improve the shelf-life of its catheters and develop next generation products and legal costs associated with ongoing litigation. In September 2020, the Company paused commercial sales of DABRA catheters not being used for the atherectomy clinical trial while it conducts further studies on the stability of its shelf life. We submitted additional test data in March 2021, which will need to be cleared by the FDA prior to resuming commercial shipments of catheters. The Company also expects the COVID-19 pandemic to have a continued negative impact on its revenue and the timing of enrollment in its atherectomy clinical trial as well as the Company’s ability to secure additional financing in a timely manner or on favorable terms, if at all. Management estimates that based on the Company’s liquidity resources, there is substantial doubt about the Company’s ability to continue as a going concern for a period of at least 12 months from the date of issuance of the financial statements. Although the Company bolstered its liquidity resources in 2020, has an effective shelf registration statement and an “at the market” offering to allow it to raise additional capital when the opportunities permit and may receive additional funds from the exercise of its warrants depending on market conditions, management concluded that the aforementioned conditions, including the ongoing uncertainty related to the negative impacts of the COVID-19 pandemic, continue to raise substantial doubt about the Company’s ability to continue as a going concern for a period of at least 12 months from the date of issuance of the financial statements. Management plans to address this uncertainty by raising additional funding, if necessary, through public or private equity or debt financings as well as by engaging in regular and ongoing reviews of our business model and strategic options to help ensure that the Company is focusing its cash resources on advancing its key corporate initiatives. However, the Company may not be able to secure such financing in a timely manner or on favorable terms, if at all. Furthermore, if the Company issues equity securities to raise additional funds, its existing stockholders may experience dilution, and the new equity securities may have rights, preferences and privileges senior to those of the Company’s existing stockholders. The financial statements have been prepared on a going concern basis, which contemplates the realization of assets and settlement of liabilities in the normal course of business, and do not include any adjustments to reflect the possible future effects on the recoverability and classification of assets or amounts and classification of liabilities that may result from the outcome of this uncertainty.

Significant Accounting Policies

Significant Accounting Policies	3 Months Ended
	Mar. 31, 2021
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Note 2—Significant Accounting Policies Interim condensed financial information —The unaudited interim condensed financial statements have been prepared on the same basis as the annual financial statements and reflect all adjustments of a normal and recurring nature that are necessary for the fair presentation of the Company’s condensed balance sheets, results of operations, cash flows and statement of stockholders’ equity for the periods presented. The results of operations for the three months ended March 31, 2021 are not necessarily indicative of the results to be expected for the year ending December 31, 2021 or for any other future annual or interim period. The balance sheet as of December 31, 2020 included herein was derived from the audited financial statements as of that date. These unaudited condensed financial statements should be read in conjunction with the Company’s audited financial statements included in the Company’s Annual Report on Form 10-K filed with the SEC on March 17, 2021. Use of estimates —The financial statements of the Company have been prepared by management in accordance with accounting principles generally accepted in the United States of America. The preparation of the financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities and reported disclosures of contingent liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Actual results could differ from those estimates. The Company’s financial statements are based upon a number of estimates, including but not limited to, allowance for doubtful accounts, reserves for warranty costs including product recalls, evaluation of probable loss contingencies, fair value of stock option awards granted and revenue recognition for multiple performance obligations. Fair value measurements — Fair value represents the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants and is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. A three-tier value hierarchy is used to identify inputs used in measuring fair value as follows: Level 1—Observable inputs that reflect quoted market prices (unadjusted) for identical assets or liabilities in active markets. Level 2—Inputs other than the quoted prices in active markets that are observable either directly or indirectly in the marketplace for identical or similar assets and liabilities; and Level 3—Unobservable inputs that are supported by little or no market data, which require the Company to develop its own assumptions. The hierarchy requires the Company to use observable market data, when available, and to minimize the use of unobservable inputs when determining fair value. The Company measures its cash and cash equivalents and short-term investments at fair value. Inventories — Inventories are stated at the lower of cost (first-in, first-out method) or net realizable value. Cost includes materials, labor and manufacturing overhead related to the purchase and production of inventories. The Company reduces the carrying value of inventories for those items that are potentially excess, obsolete or slow-moving based on changes in customer demand, technological developments or other economic factors. Catheters are manufactured in-house and each catheter is tested at various stages of the manufacturing process for adherence to quality standards. Catheters that do not meet functionality specification at each test point are destroyed and immediately written off, with the expense recorded in cost of revenue in the statements of operations. Once manufactured, completed catheters that pass quality assurance, are sent to a third-party for sterilization and sealed in a sterile container. Upon return from the third-party sterilizer, a sample of catheters from each batch are re-tested. If the sample tests are successful, the batch is accepted into finished goods inventory and if the sample tests are unsuccessful, the entire batch is written off, with the expense recorded in cost of revenue in the statements of operations. Revenue — The Company generates revenue from the sale of products and services. Product sales consist of the sale of Pharos laser systems, the sale of catheters for use with the DABRA laser, and the sale of consumables and replacement parts. The Company’s vascular segment has paused selling commercial product and is only selling catheters for use in the Company’s atherectomy clinical trial. The Company’s sales agreements generally do not include right-of-return provisions for any form of consideration including partial refund or credit against amounts owed to the Company. Services and other revenue primarily consist of sales of extended warranty and billable services, including repair activity and income from rental of lasers. Catheter Revenue When engaged in commercial sales, the Company enters into a DABRA laser commercial usage agreement or DABRA laser placement acknowledgement with each customer that is supplied a DABRA laser, collectively the “usage agreement”. The usage agreement provides for specific terms of continued use of DABRA laser, including a nominal periodic fee. The terms of a usage agreement typically allow the Company to place a DABRA laser at a customer’s specified location without a specified contract term. Under the usage agreement terms, the Company retains all ownership rights to the DABRA laser and is permitted to request the return of the equipment within 10 business days of notification. While the laser periodic fees are nominal, the laser usage agreements provide the Company the exclusive rights to supply related single-use catheters to the customer which aggregate the majority of the vascular segment revenue. There are no specified minimum purchase commitments for the catheters. The Company recognizes revenue associated with the usage agreement and catheter supply arrangements in accordance with Topic 606 as the contract primarily includes variable payments, the catheters are priced at their standalone selling price and the laser equipment is insignificant in the context of the contract. Revenue is recognized when the performance obligation is satisfied, which is generally upon shipment of the catheter. Laser Sales Sales of laser systems are included in product sales in the statements of operations. The Company recognizes revenue on laser sales at the point in time that control transfers to the customer. Control of the product typically transfers upon shipment. Warranty Service Revenue The Company typically provides a 12-month warranty with the purchase of its laser systems. Customers can extend the warranty period through the purchase of extended warranty service contracts. Extended warranty service contracts are sold with contract terms ranging from 12 to 60 months and cover periods after the end of the initial 12-month warranty period. The warranty provides the customer with maintenance services in addition to the assurance that the laser product complies with agreed-upon specifications. Therefore, the warranty service is treated as a separate performance obligation from the laser system. Warranty services are a stand-ready obligation, and the Company recognizes revenue on a straight-line basis over the service contract term. Warranty service revenue is included in service and other revenue in the statements of operations. Deferred revenue on January 1, 2021 and 2020 was $2.5 million and $3.3 million, respectively. Revenue recognized in the three months ended March 31, 2021 and 2020, relating to amounts previously included in deferred revenue was $0.6 million and $0.7 million, respectively. The deferred revenue greater than one year will be recognized during the remaining service period through 2024. Distributor Transactions In certain markets outside the U.S., the Company sells products and provides services to customers through distributors that specialize in medical device products. The terms of sales transactions through distributors are generally consistent with the terms of direct sales to customers. The Company accounts for these transactions in accordance with the Company’s revenue recognition policy described herein. Contract Costs The Company capitalizes costs to obtain contracts that are considered incremental and recoverable, such as sales commissions. The capitalized costs are amortized to selling, general and administrative expense over the estimated period of benefit of the asset, which is the contract term. The Company elected to use the practical expedient to expense the costs to obtain a contract when the amortization period is less than one year. The Company has contract costs of $0.2 million capitalized at March 31, 2021 and December 31, 2020. Rental Income The Company also derives income pursuant to product lease agreements for its Pharos laser systems, as operating leases. Consequently, the Company retains title to the equipment and the equipment remains on Company’s balance sheet within property and equipment. Depreciation expense on these leased lasers is recorded to cost of revenues on a straight-line basis. The costs to maintain these leased lasers are charged to cost of revenues as incurred. These lease arrangements contain one lease component (the laser) and one nonlease component (warranty service) for which the Company elected the practical expedient to not separate the nonlease component from the lease component. The Company accounts for the combined lease component as an operating lease and recognizes lease income on a straight-line basis over the lease term. Rental income from lease arrangements for each of the three months ended March 31, 2021 and March 31, 2020 was $0.1 million and $0.2 million, respectively.

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2021
Fair Value Disclosures [Abstract]
Fair Value Measurements	Note 3—Fair Value Measurements The following table presents the hierarchy for assets measured at fair value on a recurring basis (in thousands): Total Fair Value Quoted Market Prices for Identical Assets (Level 1) Other Observable Inputs (Level 2) Unobservable Inputs (Level 3) As of March 31, 2021 Money market funds $ 12,394 $ 12,394 $ — $ — As of December 31, 2020 Money market funds $ 18,394 $ 18,394 $ — $ —

Inventories

Inventories	3 Months Ended
	Mar. 31, 2021
Inventory Disclosure [Abstract]
Inventories	Inventories consisted of the following (in thousands): March 31, 2021 December 31, 2020 Raw materials $ 1,834 $ 1,739 Work in process 283 270 Finished goods 132 209 Inventories $ 2,249 $ 2,218

Property and Equipment, Net

Property and Equipment, Net	3 Months Ended
	Mar. 31, 2021
Property Plant And Equipment Net [Abstract]
Property and Equipment, Net	Note 5—Property and Equipment, net Property and equipment consisted of the following (in thousands): March 31, 2021 December 31, 2020 Lasers $ 4,545 $ 4,677 Machinery and equipment 937 866 Automobiles 116 1,054 Computer hardware and software 353 353 Leasehold improvements 119 119 Furniture and fixtures 48 48 Construction in progress — 51 Property and equipment, gross 6,118 7,168 Accumulated depreciation (3,298 ) (3,957 ) Property and equipment, net $ 2,820 $ 3,211 Depreciation expense was $0.4 million and $0.5 million for the three months ended March 31, 2021

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2021
Payables And Accruals [Abstract]
Accrued Expenses	Note 6—Accrued Expenses Accrued expenses consisted of the following (in thousands): March 31, 2021 December 31, 2020 Compensation and related benefits $ 729 $ 2,602 Accrued warranty (Note 7) 243 242 Accrued services 1,241 1,504 Accrued expenses $ 2,213 $ 4,348

Accrued Warranty

Accrued Warranty	3 Months Ended
	Mar. 31, 2021
Product Warranties Disclosures [Abstract]
Accrued Warranty	Note 7—Accrued Warranty Activity in the product warranty accrual is included in accrued expenses above and consists of the following (in thousands): Three Months Ended March 31, 2021 Year Ended December 31, 2020 Balance at beginning of period $ 242 $ 338 Increase in warranty accrual 24 87 Change in liability for pre-existing warranties — (2 ) Claims satisfied (23 ) (181 ) Accrued warranty $ 243 $ 242 Warranty expense was $24,000 and $32,000 for the three months ended March 31, 2021 and 2020, respectively. of catheters, which occurred in September 2019.

Paycheck Protection Program Pro

Paycheck Protection Program Promissory Note	3 Months Ended
	Mar. 31, 2021
Paycheck Protection Program Promissory Note [Abstract]
Paycheck Protection Program Promissory Note	Note 8—Paycheck Protection Program Promissory Note In May 2020, the Company entered into a $2.0 million Paycheck Protection Program Promissory Note and Agreement (“PPP Promissory Note”) with a commercial bank under the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. The PPP Promissory Note bears interest at 1.0% per annum. Under the terms of the PPP Promissory Note, payments would have been due monthly beginning November 1, 2020 and the principal amount of the PPP Promissory Note along with any unpaid interest would be due on May 3, 2022. On June 5, 2020, the Paycheck Protection Program Flexibility Act of 2020 (the “PPPFA”) extended the deferral period for all loans to 10 months after the last day of the covered period. Under the revised terms, payments are due beginning August 2021 and the principal amount along with unpaid interest is due in May 2022. The Company has requested from its lender an extension of the loan maturity from two years to five years as permitted under the PPPFA. The principal and interest may be forgiven if the proceeds are used for forgivable purposes as defined by the terms in the PPP Promissory Note, and the Company believes it has used the proceeds from the PPP Promissory Note for forgivable purposes as defined by the terms of the PPP Promissory Note. The Company applied for forgiveness under the provisions of the CARES Act in March 2021. Forgiveness is subject to the sole approval of the Small Business Administration. Interest expense for the three months ended March 31, 2021 was $5,000.

Leases

Leases	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Leases	Note 9—Leases The Company has two operating leases for office and manufacturing space which requires it to pay base rent and certain utilities. Monthly rent expense is recognized on a straight-line basis over the terms of the leases, which expire in 2027 and 2021. At March 31, 2021, the weighted average remaining lease term was seven years. The operating leases are included in the balance sheet at the present value of the lease payments at a 7% discount rate, which approximates using the rate of interest that the Company would have to pay to borrow on a collateralized basis over a similar term and amount equal to the lease payments in a similar economic environment as the leases do not provide an implicit rate. For each of the three months ended March 31, 2021 and 2020, operating lease expense and cash paid for leases were $0.1 million. O The following table presents the lease liabilities within the condensed balance sheet, related to the Company’s operating leases as of March 31, 2021 (in thousands): Years Ending December 31, 2021 (remaining nine months) $ 396 2022 432 2023 445 2024 459 2025 472 2026 486 Thereafter 501 Total operating lease payments $ 3,191 Less: imputed interest (658 ) Total operating lease liabilities $ 2,533

Loss per Share

Loss per Share	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Loss per Share	Note 10—Loss per Share The Company calculates basic loss per share by dividing net loss by the weighted average number of common shares outstanding during the reporting period. A net loss cannot be diluted, so when the Company is in a net loss position, basic and diluted loss per common share are the same. If in the future the Company achieves profitability, the denominator of a diluted earnings per common share calculation will include both the weighted-average number of shares outstanding and the number of common stock equivalents, if the inclusion of such common stock equivalents would be dilutive. Dilutive common stock equivalents potentially include warrants, stock options and non-vested restricted stock awards and units using the treasury stock method, along with the effect, if any, from outstanding convertible securities. The Company’s outstanding warrants to purchase common stock have participation rights to any dividends that may be declared in the future and are therefore considered to be participating securities. Participating securities have the effect of diluting both basic and diluted earnings per share during periods of income. During periods of loss, no loss is allocated to the participating securities since the holders have no contractual obligation to share in the losses of the Company. Anti-dilutive common share equivalents excluded from the computation of diluted net loss per share at March 31, 2021 consisted of warrants of 2,345,033, stock options of 136,033, restricted stock units of 38,922, restricted stock awards of 325,429 and Employee Stock Purchase Plan shares of 3,200. Anti-dilutive common share equivalents excluded from the computation of diluted net loss per share at March 31, 2020 consisted of stock options of 148,896, restricted stock units of 11,905, restricted stock awards of 5,000 and Employee Stock Purchase Plan shares of 2,473.

Equity Offering

Equity Offering	3 Months Ended
	Mar. 31, 2021
Equity [Abstract]
Equity Offering	Note 11—Equity Offering In February 2021, the Company completed an “at the market offering” of 35,768 shares of common stock, at a price of $ Securities and Exchange Commission

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2021
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock-Based Compensation	Note 12—Stock-Based Compensation A summary of the activity and related information of the stock options issued under the 2018 Equity Incentive Plan 2018 Stock Compensation Plan Stock Options Weighted Average Exercise Price Weighted Average Remaining Life (in years) Aggregate Intrinsic Value (in thousands) Outstanding at December 31, 2020 124,171 $ 363.31 $ — Granted — Forfeited (6,138 ) 53.87 Outstanding at March 31, 2021 118,033 $ 379.41 6.43 $ — Exercisable at March 31, 2021 93,085 $ 455.45 5.88 $ — Vested and expected to vest at March 31, 2021 118,033 $ 379.41 6.43 $ — A summary of the activity and related information of the restricted stock units issued under the 2018 Plan is presented below: Restricted Stock Units Weighted Average Grant Date Fair Value Outstanding at December 31, 2020 33,548 $ 21.93 Granted 5,447 7.18 Vested and released — — Forfeited (73 ) 144.14 Outstanding at March 31, 2021 38,922 $ 19.64 A summary of the activity and related information of the restricted stock awards issued under the 2018 Plan is presented below: Restricted Stock Awards (in shares) Weighted Average Grant Date Fair Value Outstanding at December 31, 2020 286,161 $ 4.77 Granted 34,893 7.11 Forfeited — — Vested — — Outstanding at March 31, 2021 321,054 $ 5.03 Stock-based compensation expense recorded in operating expenses was as follows (in thousands): Three Months Ended March 31, 2021 2020 Selling, general and administrative $ 962 $ 862 Research and development 129 99 Stock-based compensation in operating expenses $ 1,091 $ 961 Stock-based compensation amounts of $0.1 million were capitalized to inventory and property and equipment during each of the three months ended March 31, 2021 and 2020, respectively. Unrecognized compensation expense for stock options issued as of March 31, 2021 was $0.9 million and is expected to be recognized over a weighted-average period of 1.5 years. Unrecognized compensation expense for the restricted stock units as of March 31, 2021 was $0.5 million and is expected to be recognized over a weighted-average period of 1.9 years. Unrecognized compensation expense for the restricted stock awards as of March 31, 2021 was $1.3 million and is expected to be recognized over a weighted-average period of 2.3 years.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	Note 13—Commitments and Contingencies Legal —In the normal course of business, the Company is at times subject to pending and threatened legal actions. In management’s opinion, any potential loss resulting from the resolution of these matters will not have a material effect on the results of operations, financial position or cash flows of the Company. Securities Litigation On June 7, 2019, a putative securities class action complaint captioned Derr v. Ra Medical Systems, Inc., et. al., On March 24, 2021, the court issued an order granting defendants’ motion to dismiss claims under the Securities Act in full and certain claims under the Exchange Act, and denying defendants’ motion to dismiss certain Exchange Act claims. Plaintiffs filed their second amended complaint on April 19, 2021, realleging the Securities Act claims and certain of the previously dismissed Exchange Act claims. On October 1, 2019, a shareholder derivative complaint captioned Noel Borg v. Dean Irwin, et. al Governmental Investigations As previously announced in the Form 8-K filed on August 12, 2019, the Audit Committee of Ra Medical’s Board of Directors (the “Audit Committee”) conducted an investigation of certain allegations raised by a former employee. The Company announced the Audit Committee’s findings in the Form 8-K filed on October 31, 2019. The primary investigative findings were: (i) the DABRA catheter frequently failed to calibrate and occasionally overheated, posing a risk of injury to physicians and patients; (ii) the Company’s explanations regarding its fourth quarter 2018 and first quarter 2019 sales created a risk of confusion because they did not explicitly reference inconsistent DABRA catheter performance and catheter failures; (iii) the Company failed to timely make at least two Medical Device Reports, or MDRs, to the FDA; (iv) the Company, out of a concern for the DABRA catheters’ performance, engaged in systematic efforts to replace product held by customers, which constituted product recalls, but were not documented as such, (v) the Company lack documentation of sufficient detail and specificity to support certain payments to physicians, ostensibly for training and consulting services, and as to three physicians did not accurately reflect the purpose and nature of approximately $300,000 of payments, which could be perceived as an improper attempt to obtain business or to gain special advantage, (vi) while the indication for use in the 510(k) clearance the Company obtained for the DABRA system is not for atherectomy, the Company’s salespeople were instructed to characterize DABRA as performing atherectomy and to encourage doctors to seek reimbursement using atherectomy codes, (vii) the Company’s determinations to direct potentially valuable benefits and opportunities to doctors were informed in part by sales prospects, and (viii) the Company received complaints regarding regulatory or compliance concerns that, because they implicated executive officers, should have been brought to the attention of the Board or the Audit Committee, but were not. On December 28, 2020, the Company entered into a Settlement Agreement with the United States of America, acting through the DOJ and on behalf of the OIG, to resolve the pending DOJ investigation and a related civil action concerning our marketing of the DABRA laser system and DABRA-related remuneration to certain physicians. In connection with the Settlement Agreement, the Company also has reached agreements with the participating states that resolve previously disclosed related investigations conducted by certain state attorneys general. The Settlement Agreement recites that a complaint filed by a former employee on behalf of the federal government in the United States District Court for the Eastern District of Michigan, and subsequently amended to assert claims on behalf of certain states, alleged, among other things, that the Company violated the False Claims Act, 31 U.S.C. § 3729, and certain state false claims acts by paying kickbacks to certain physicians in order to induce them to use the DABRA laser system, promoting off-label use of the DABRA laser system, failing to report adverse events to the United States Food and Drug Administration, marketing a device that does not work as advertised, and failing to adhere to Current Good Manufacturing Practices. The complaint, which was settled in connection with the Settlement Agreement, also alleged that we unlawfully retaliated against the former employee. Under the Settlement Agreement, and the agreements with the participating states, the Company is required to make an initial payment of $2.5 million, of which the Company paid $2.4 million in December 2020 and $0.1 million in April 2021. Pursuant to the terms of the Settlement Agreement, (a) if its revenue exceeds $10 million in any of the next four fiscal years (2021-2024), it also is required to pay an additional amount in settlement for the corresponding year: $500,000 for 2021, $750,000 for 2022, $1 million for 2023, and $1.25 million for 2024; (b) if it is acquired or is otherwise involved in a change in control transaction in the years 2020 through 2024, it is required to pay an additional settlement amount of $5 million, plus 4% of the value attributed to the Company in the transaction, so long as the attributed value is in excess of $100 million, with the total change in control payment never to exceed $28 million; and (c) if its obligations under the Settlement Agreement are avoided by bankruptcy, the United States may rescind the releases and bring an action against the Company in which the Company agrees is not subject to an automatic stay, is not subject to any statute of limitations, estoppel or laches defense, and is a valid claim in the amount of $56 million, minus any prior change in control payments. Under the Settlement Agreement, the Company also paid the former employee’s reasonable expenses, costs and attorneys’ fees, which amount to $0.2 million. The Company has expensed $2.7 million during the year ended December 31, 2020 and has remaining accrued expenses of $0.1 million at March 31, 2021 relating to this matter. The OIG has agreed, conditioned upon our full payment of amounts owed in the Settlement Agreement, and in consideration of the Company’s obligations under a Corporate Integrity Agreement, to release its permissive exclusion rights and refrain from instituting any administrative action seeking to exclude it from participating in Medicare, Medicaid, or other federal health care programs as a result of the Covered Conduct. The Corporate Integrity Agreement has a five-year term and imposes monitoring, reporting, certification, documentation, oversight, screening, and training obligations on the Company, including the hiring of a compliance officer and independent review organization. Pursuant to the terms of the Settlement Agreement, the United States and the former employee have dismissed the complaint against the Company with prejudice, and have released the Company from any civil or administrative monetary liability arising under the Covered Conduct. The Settlement Agreement does not include a release for any conduct other than the Covered Conduct or any criminal liability related to the Covered Conduct. The Settlement Agreement does not release any claims under investigation by the SEC. As also previously announced, the Company voluntarily contacted the SEC’s Enforcement Division regarding the Audit Committee’s investigation. On November 13, 2019, the SEC notified the Company that it is conducting an investigation. The Company has been, and intends to continue, cooperating with the SEC in this ongoing investigation. The Company is unable to predict the ultimate outcome and is unable to make a meaningful estimate of the amount or range of loss, if any, that could result from any unfavorable outcome. On November 21, 2019, the Company became aware that the Criminal Division, Fraud Section of the DOJ has an open investigation related to the Company. At this time, it is unclear if the Company is a target in this investigation. The Company has been, and intends to continue, cooperating with the DOJ in its active and ongoing investigation. The Company is unable to predict the ultimate outcome and is unable to make a meaningful estimate of the amount or range of loss, if any, that could result from any unfavorable outcome.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Segment Information	Note 14—Segment Information The Company has organized its business into two operating segments based on the product specialties: the vascular segment and the dermatology segment. In deciding how to allocate resources and assess performance, the Company’s chief operating decision maker regularly evaluates the sales and gross profit of these segments. Amounts included within selling, general and administrative expense and research and development expense are general to the Company and not specific to a particular segment; therefore, these amounts are not evaluated by the Company’s chief operating decision maker on a segmented basis. The following tables summarize segment performance (in thousands): Three Months Ended March 31, 2021 2020 Vascular $ 4 $ 113 Dermatology 1,114 1,261 Net revenue $ 1,118 $ 1,374 Vascular $ 399 $ 661 Dermatology 974 923 Cost of revenue $ 1,373 $ 1,584 Vascular $ (395 ) $ (548 ) Dermatology 140 338 Gross loss $ (255 ) $ (210 ) Generally, all assets are common assets, except for lasers placed with customers, which are a subset of property and equipment. The net book value of the lasers in the vascular segment was $1.7 million and $1.9 million as of March 31, 2021 and December 31, 2020, respectively. The net book value of the lasers in the dermatology segment was $0.5 million and $0.7 million as of March 31, 2021 and December 31, 2020, respectively. No sales to an individual customer or country other than the United States accounted for more than 10% of revenue for the three months ended March 31, 2021 and 2020. Net revenue, classified by the major geographic areas in which our customers are located, was as follows (in thousands): Three Months Ended March 31, 2021 2020 United States $ 1,063 $ 1,186 All other countries 55 188 Net revenue $ 1,118 $ 1,374

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2021
Accounting Policies [Abstract]
Interim Condensed Financial Information	Interim condensed financial information —The unaudited interim condensed financial statements have been prepared on the same basis as the annual financial statements and reflect all adjustments of a normal and recurring nature that are necessary for the fair presentation of the Company’s condensed balance sheets, results of operations, cash flows and statement of stockholders’ equity for the periods presented. The results of operations for the three months ended March 31, 2021 are not necessarily indicative of the results to be expected for the year ending December 31, 2021 or for any other future annual or interim period. The balance sheet as of December 31, 2020 included herein was derived from the audited financial statements as of that date. These unaudited condensed financial statements should be read in conjunction with the Company’s audited financial statements included in the Company’s Annual Report on Form 10-K filed with the SEC on March 17, 2021.
Use of Estimates	Use of estimates —The financial statements of the Company have been prepared by management in accordance with accounting principles generally accepted in the United States of America. The preparation of the financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities and reported disclosures of contingent liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Actual results could differ from those estimates. The Company’s financial statements are based upon a number of estimates, including but not limited to, allowance for doubtful accounts, reserves for warranty costs including product recalls, evaluation of probable loss contingencies, fair value of stock option awards granted and revenue recognition for multiple performance obligations.
Fair Value Measurements	Fair value measurements — Fair value represents the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants and is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. A three-tier value hierarchy is used to identify inputs used in measuring fair value as follows: Level 1—Observable inputs that reflect quoted market prices (unadjusted) for identical assets or liabilities in active markets. Level 2—Inputs other than the quoted prices in active markets that are observable either directly or indirectly in the marketplace for identical or similar assets and liabilities; and Level 3—Unobservable inputs that are supported by little or no market data, which require the Company to develop its own assumptions. The hierarchy requires the Company to use observable market data, when available, and to minimize the use of unobservable inputs when determining fair value. The Company measures its cash and cash equivalents and short-term investments at fair value.
Inventories	Inventories — Inventories are stated at the lower of cost (first-in, first-out method) or net realizable value. Cost includes materials, labor and manufacturing overhead related to the purchase and production of inventories. The Company reduces the carrying value of inventories for those items that are potentially excess, obsolete or slow-moving based on changes in customer demand, technological developments or other economic factors. Catheters are manufactured in-house and each catheter is tested at various stages of the manufacturing process for adherence to quality standards. Catheters that do not meet functionality specification at each test point are destroyed and immediately written off, with the expense recorded in cost of revenue in the statements of operations. Once manufactured, completed catheters that pass quality assurance, are sent to a third-party for sterilization and sealed in a sterile container. Upon return from the third-party sterilizer, a sample of catheters from each batch are re-tested. If the sample tests are successful, the batch is accepted into finished goods inventory and if the sample tests are unsuccessful, the entire batch is written off, with the expense recorded in cost of revenue in the statements of operations.
Revenue	Revenue — The Company generates revenue from the sale of products and services. Product sales consist of the sale of Pharos laser systems, the sale of catheters for use with the DABRA laser, and the sale of consumables and replacement parts. The Company’s vascular segment has paused selling commercial product and is only selling catheters for use in the Company’s atherectomy clinical trial. The Company’s sales agreements generally do not include right-of-return provisions for any form of consideration including partial refund or credit against amounts owed to the Company. Services and other revenue primarily consist of sales of extended warranty and billable services, including repair activity and income from rental of lasers. Catheter Revenue When engaged in commercial sales, the Company enters into a DABRA laser commercial usage agreement or DABRA laser placement acknowledgement with each customer that is supplied a DABRA laser, collectively the “usage agreement”. The usage agreement provides for specific terms of continued use of DABRA laser, including a nominal periodic fee. The terms of a usage agreement typically allow the Company to place a DABRA laser at a customer’s specified location without a specified contract term. Under the usage agreement terms, the Company retains all ownership rights to the DABRA laser and is permitted to request the return of the equipment within 10 business days of notification. While the laser periodic fees are nominal, the laser usage agreements provide the Company the exclusive rights to supply related single-use catheters to the customer which aggregate the majority of the vascular segment revenue. There are no specified minimum purchase commitments for the catheters. The Company recognizes revenue associated with the usage agreement and catheter supply arrangements in accordance with Topic 606 as the contract primarily includes variable payments, the catheters are priced at their standalone selling price and the laser equipment is insignificant in the context of the contract. Revenue is recognized when the performance obligation is satisfied, which is generally upon shipment of the catheter. Laser Sales Sales of laser systems are included in product sales in the statements of operations. The Company recognizes revenue on laser sales at the point in time that control transfers to the customer. Control of the product typically transfers upon shipment. Warranty Service Revenue The Company typically provides a 12-month warranty with the purchase of its laser systems. Customers can extend the warranty period through the purchase of extended warranty service contracts. Extended warranty service contracts are sold with contract terms ranging from 12 to 60 months and cover periods after the end of the initial 12-month warranty period. The warranty provides the customer with maintenance services in addition to the assurance that the laser product complies with agreed-upon specifications. Therefore, the warranty service is treated as a separate performance obligation from the laser system. Warranty services are a stand-ready obligation, and the Company recognizes revenue on a straight-line basis over the service contract term. Warranty service revenue is included in service and other revenue in the statements of operations. Deferred revenue on January 1, 2021 and 2020 was $2.5 million and $3.3 million, respectively. Revenue recognized in the three months ended March 31, 2021 and 2020, relating to amounts previously included in deferred revenue was $0.6 million and $0.7 million, respectively. The deferred revenue greater than one year will be recognized during the remaining service period through 2024. Distributor Transactions In certain markets outside the U.S., the Company sells products and provides services to customers through distributors that specialize in medical device products. The terms of sales transactions through distributors are generally consistent with the terms of direct sales to customers. The Company accounts for these transactions in accordance with the Company’s revenue recognition policy described herein. Contract Costs The Company capitalizes costs to obtain contracts that are considered incremental and recoverable, such as sales commissions. The capitalized costs are amortized to selling, general and administrative expense over the estimated period of benefit of the asset, which is the contract term. The Company elected to use the practical expedient to expense the costs to obtain a contract when the amortization period is less than one year. The Company has contract costs of $0.2 million capitalized at March 31, 2021 and December 31, 2020. Rental Income The Company also derives income pursuant to product lease agreements for its Pharos laser systems, as operating leases. Consequently, the Company retains title to the equipment and the equipment remains on Company’s balance sheet within property and equipment. Depreciation expense on these leased lasers is recorded to cost of revenues on a straight-line basis. The costs to maintain these leased lasers are charged to cost of revenues as incurred. These lease arrangements contain one lease component (the laser) and one nonlease component (warranty service) for which the Company elected the practical expedient to not separate the nonlease component from the lease component. The Company accounts for the combined lease component as an operating lease and recognizes lease income on a straight-line basis over the lease term. Rental income from lease arrangements for each of the three months ended March 31, 2021 and March 31, 2020 was $0.1 million and $0.2 million, respectively.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2021
Short Term Investments [Abstract]
Summary of Hierarchy for Assets Measured at Fair Value on a Recurring Basis	The following table presents the hierarchy for assets measured at fair value on a recurring basis (in thousands): Total Fair Value Quoted Market Prices for Identical Assets (Level 1) Other Observable Inputs (Level 2) Unobservable Inputs (Level 3) As of March 31, 2021 Money market funds $ 12,394 $ 12,394 $ — $ — As of December 31, 2020 Money market funds $ 18,394 $ 18,394 $ — $ —

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2021
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consisted of the following (in thousands): March 31, 2021 December 31, 2020 Raw materials $ 1,834 $ 1,739 Work in process 283 270 Finished goods 132 209 Inventories $ 2,249 $ 2,218

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	3 Months Ended
	Mar. 31, 2021
Property Plant And Equipment Net [Abstract]
Schedule of Property and Equipment	Property and equipment consisted of the following (in thousands): March 31, 2021 December 31, 2020 Lasers $ 4,545 $ 4,677 Machinery and equipment 937 866 Automobiles 116 1,054 Computer hardware and software 353 353 Leasehold improvements 119 119 Furniture and fixtures 48 48 Construction in progress — 51 Property and equipment, gross 6,118 7,168 Accumulated depreciation (3,298 ) (3,957 ) Property and equipment, net $ 2,820 $ 3,211

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2021
Payables And Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consisted of the following (in thousands): March 31, 2021 December 31, 2020 Compensation and related benefits $ 729 $ 2,602 Accrued warranty (Note 7) 243 242 Accrued services 1,241 1,504 Accrued expenses $ 2,213 $ 4,348

Accrued Warranty (Tables)

Accrued Warranty (Tables)	3 Months Ended
	Mar. 31, 2021
Product Warranties Disclosures [Abstract]
Schedule Product Warranty Accrual Included in Accrued Expenses	Activity in the product warranty accrual is included in accrued expenses above and consists of the following (in thousands): Three Months Ended March 31, 2021 Year Ended December 31, 2020 Balance at beginning of period $ 242 $ 338 Increase in warranty accrual 24 87 Change in liability for pre-existing warranties — (2 ) Claims satisfied (23 ) (181 ) Accrued warranty $ 243 $ 242

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Schedule of Operating Lease Maturities	The following table presents the lease liabilities within the condensed balance sheet, related to the Company’s operating leases as of March 31, 2021 (in thousands): Years Ending December 31, 2021 (remaining nine months) $ 396 2022 432 2023 445 2024 459 2025 472 2026 486 Thereafter 501 Total operating lease payments $ 3,191 Less: imputed interest (658 ) Total operating lease liabilities $ 2,533

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2021
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Schedule of Restricted Stock Units Activity	A summary of the activity and related information of the restricted stock units issued under the 2018 Plan is presented below: Restricted Stock Units Weighted Average Grant Date Fair Value Outstanding at December 31, 2020 33,548 $ 21.93 Granted 5,447 7.18 Vested and released — — Forfeited (73 ) 144.14 Outstanding at March 31, 2021 38,922 $ 19.64
Schedule of Restricted Stock Awards Activity	A summary of the activity and related information of the restricted stock awards issued under the 2018 Plan is presented below: Restricted Stock Awards (in shares) Weighted Average Grant Date Fair Value Outstanding at December 31, 2020 286,161 $ 4.77 Granted 34,893 7.11 Forfeited — — Vested — — Outstanding at March 31, 2021 321,054 $ 5.03
Stock Options [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Schedule of Options Activity	A summary of the activity and related information of the stock options issued under the 2018 Equity Incentive Plan 2018 Stock Compensation Plan Stock Options Weighted Average Exercise Price Weighted Average Remaining Life (in years) Aggregate Intrinsic Value (in thousands) Outstanding at December 31, 2020 124,171 $ 363.31 $ — Granted — Forfeited (6,138 ) 53.87 Outstanding at March 31, 2021 118,033 $ 379.41 6.43 $ — Exercisable at March 31, 2021 93,085 $ 455.45 5.88 $ — Vested and expected to vest at March 31, 2021 118,033 $ 379.41 6.43 $ —
Schedule of Stock-based Compensation Expense Recorded in Operating Expenses	Stock-based compensation expense recorded in operating expenses was as follows (in thousands): Three Months Ended March 31, 2021 2020 Selling, general and administrative $ 962 $ 862 Research and development 129 99 Stock-based compensation in operating expenses $ 1,091 $ 961

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Schedule of Segment Performance	The following tables summarize segment performance (in thousands): Three Months Ended March 31, 2021 2020 Vascular $ 4 $ 113 Dermatology 1,114 1,261 Net revenue $ 1,118 $ 1,374 Vascular $ 399 $ 661 Dermatology 974 923 Cost of revenue $ 1,373 $ 1,584 Vascular $ (395 ) $ (548 ) Dermatology 140 338 Gross loss $ (255 ) $ (210 )
Schedule of Net Revenue Classified by Major Geographical Areas	No sales to an individual customer or country other than the United States accounted for more than 10% of revenue for the three months ended March 31, 2021 and 2020. Net revenue, classified by the major geographic areas in which our customers are located, was as follows (in thousands): Three Months Ended March 31, 2021 2020 United States $ 1,063 $ 1,186 All other countries 55 188 Net revenue $ 1,118 $ 1,374

Organization and Nature of Op_2

Organization and Nature of Operations - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Jul. 14, 2018	Jul. 13, 2018
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Common stock, par value	$ 0.0001		$ 0.0001	$ 0.0001
Common stock, shares authorized	300,000,000		300,000,000	25,000,000	10,000,000
Preferred stock, par value	$ 0.0001		$ 0.0001
Preferred stock, shares authorized	10,000,000		10,000,000
Accumulated deficit	$ 160,438		$ 153,202
Net cash used in operating activities	8,078	$ 7,043	28,300
Cash and cash equivalents	$ 15,954		$ 23,906

Significant Accounting Polici_3

Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Jan. 01, 2021	Dec. 31, 2020	Jan. 01, 2020
Deferred revenue			$ 2.5		$ 3.3
Deferred revenue, recognized	$ 0.6	$ 0.7
Remaining service period to recognize deferred revenue, description	2024
Capitalized contract cost, net	$ 0.2			$ 0.2
Laser revenue	$ 0.1	$ 0.2
Minimum [Member]
Regular warranty service contracts term	12 months
Maximum [Member]
Extended warranty service contracts term	60 months
Capitalized contract cost amortization period	1 year

Fair Value Measurements - Summa

Fair Value Measurements - Summary of Hierarchy for Assets Measured at Fair Value on a Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - Money market Funds [Member] - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Total Fair Value	$ 12,394	$ 18,394
Quoted Market Prices for Identical Assets (Level 1) [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Total Fair Value	$ 12,394	$ 18,394

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 1,834	$ 1,739
Work in process	283	270
Finished goods	132	209
Inventories	$ 2,249	$ 2,218

Property and Equipment, Net - S

Property and Equipment, Net - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 6,118	$ 7,168
Accumulated depreciation	(3,298)	(3,957)
Property and equipment, net	2,820	3,211
Lasers [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	4,545	4,677
Machinery And Equipment [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	937	866
Automobiles [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	116	1,054
Computer Hardware And Software [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	353	353
Leasehold Improvements [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	119	119
Furniture And Fixtures [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 48	48
Construction In Progress [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross		$ 51

Property and Equipment, Net - A

Property and Equipment, Net - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Property Plant And Equipment [Line Items]
Depreciation	$ 0.4	$ 0.5
Automobiles [Member] | General and Administrative Expense [Member]
Property Plant And Equipment [Line Items]
Gain on Sale of Property and Equipment	$ 0.5

Accrued Expenses - Schedule of

Accrued Expenses - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019
Payables And Accruals [Abstract]
Compensation and related benefits	$ 729	$ 2,602
Accrued warranty (Note 7)	243	242	$ 242	$ 338
Accrued services	1,241	1,504
Accrued expenses	$ 2,213	$ 4,348

Accrued Warranty - Schedule Pro

Accrued Warranty - Schedule Product Warranty Accrual Included in Accrued Expenses (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Product Warranties Disclosures [Abstract]
Balance at beginning of period, Accrued warranty	$ 242	$ 338
Increase in warranty accrual	24	87
Change in liability for pre-existing warranties		(2)
Claims satisfied	(23)	(181)
Balance at ending of period, Accrued warranty	$ 243	$ 242

Accrued Warranty - Additional I

Accrued Warranty - Additional Information (Details) - USD ($)	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Product Warranty Liability [Line Items]
Warranty expense	$ 24,000	$ 32,000
Accrued warranty (Note 7)	243,000	$ 242,000	$ 242,000	$ 338,000
Catheters [Member] | Product Recall [Member]
Product Warranty Liability [Line Items]
Accrued warranty (Note 7)	$ 100,000		$ 100,000

Paycheck Protection Program P_2

Paycheck Protection Program Promissory Note - Additional Information (Details) - USD ($)	1 Months Ended	3 Months Ended
	May 31, 2020	Mar. 31, 2021	Mar. 31, 2020
Interest expense		$ 52,000	$ 25,000
PPP Promissory Note [Member] | Corona Virus Aid Relief Economic Security Act
Paycheck protection program, amount	$ 2,000,000
Interest rate	1.00%
Payments due, beginning date	Nov. 1, 2020
Payments due, ending date	May 3, 2022
Interest expense		$ 5,000
Deferral period for all loans		10 months
Debt instrument, description		payments are due beginning August 2021 and the principal amount along with unpaid interest is due in May 2022. The Company has requested from its lender an extension of the loan maturity from two years to five years as permitted under the PPPFA. The principal and interest may be forgiven if the proceeds are used for forgivable purposes as defined by the terms in the PPP Promissory Note, and the Company believes it has used the proceeds from the PPP Promissory Note for forgivable purposes as defined by the terms of the PPP Promissory Note.
PPP Promissory Note [Member] | Corona Virus Aid Relief Economic Security Act | Minimum [Member]
Extended maturity period		2 years
PPP Promissory Note [Member] | Corona Virus Aid Relief Economic Security Act | Maximum [Member]
Extended maturity period		5 years

Leases - Additional Information

Leases - Additional Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021USD ($)Lease	Mar. 31, 2020USD ($)
Operating Leased Assets [Line Items]
Number of leases | Lease	2
Operating lease, discount rate	7.00%
Operating lease, weighted average remaining lease term	7 years
Operating lease expense	$ 0.1	$ 0.1
Operating lease , cash payment	0.1	0.1
Operating lease right-of-use-assets amortization	$ 0.1	$ 0.1
Office Building [Member]
Operating Leased Assets [Line Items]
Lease expiration period	2027
Manufacturing Facility [Member]
Operating Leased Assets [Line Items]
Lease expiration period	2021

Leases - Lease Liabilities Rela

Leases - Lease Liabilities Related to Operating Leases Presented within Condensed Balance Sheet (Details) $ in Thousands	Mar. 31, 2021USD ($)
Leases [Abstract]
2021 (remaining nine months)	$ 396
2022	432
2023	445
2024	459
2025	472
2026	486
Thereafter	501
Total operating lease payments	3,191
Less: imputed interest	(658)
Total operating lease liabilities	$ 2,533

Loss per Share - Additional Inf

Loss per Share - Additional Information (Details) - USD ($)	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Loss allocated to participating securities	$ 0
Stock Options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive common share equivalents excluded from computation of diluted net loss per share	136,033	148,896
Warrants [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive common share equivalents excluded from computation of diluted net loss per share	2,345,033
Restricted Stock Awards (RSAs) [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive common share equivalents excluded from computation of diluted net loss per share	325,429	5,000
Employee Stock Purchase Plan [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive common share equivalents excluded from computation of diluted net loss per share	3,200	2,473
Restricted Stock Units (RSUs) [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive common share equivalents excluded from computation of diluted net loss per share	38,922	11,905

Equity Offering - Additional In

Equity Offering - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Feb. 28, 2021	Mar. 31, 2021	Dec. 31, 2020	Jul. 14, 2018	Jul. 13, 2018
Class Of Stock [Line Items]
Common stock, shares authorized		300,000,000	300,000,000	25,000,000	10,000,000
Common stock, par value		$ 0.0001	$ 0.0001	$ 0.0001
At The Market Offering [Member]
Class Of Stock [Line Items]
Common stock, shares authorized	35,768
Common stock, par value	$ 8.3921
Proceeds from issuance of common stock	$ 0.3
Other offering expenses	$ 0.2

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Options Activity (Details)	3 Months Ended
	Mar. 31, 2021$ / sharesshares
Weighted Average Remaining Life (in years)
Weighted Average Remaining Life (in years)	1 year 6 months
Stock Options [Member]
Options outstanding
Beginning balance | shares	124,171
Forfeited | shares	(6,138)
Ending balance | shares	118,033
Exercisable at the end of the period | shares	93,085
Vested and expected to vest at the end of the period | shares	118,033
Weighted Average Exercise Price
Beginning balance | $ / shares	$ 363.31
Forfeited | $ / shares	53.87
Ending balance | $ / shares	379.41
Exercisable at the end of the period | $ / shares	455.45
Vested and expected to vest at the end of the period | $ / shares	$ 379.41
Weighted Average Remaining Life (in years)
Weighted Average Remaining Life (in years)	6 years 5 months 4 days
Exercisable at the end of the period	5 years 10 months 17 days
Vested and expected to vest at the end of the period	6 years 5 months 4 days

Stock-Based Compensation - Sc_2

Stock-Based Compensation - Schedule of Restricted Stock Units Activity (Details) - Restricted Stock Units (RSUs) [Member]	3 Months Ended
	Mar. 31, 2021$ / sharesshares
Restricted Stock Units
Beginning balance | shares	33,548
Granted | shares	5,447
Vested and released | shares	0
Forfeited | shares	(73)
Ending balance | shares	38,922
Weighted Average Grant Date Fair Value
Beginning balance | $ / shares	$ 21.93
Granted | $ / shares	7.18
Vested and released | $ / shares	0
Forfeited | $ / shares	144.14
Ending balance | $ / shares	$ 19.64

Stock-Based Compensation - Sc_3

Stock-Based Compensation - Schedule of Restricted Stock Awards Activity (Details) - Restricted Stock	3 Months Ended
	Mar. 31, 2021$ / sharesshares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Beginning balance | shares	286,161
Granted | shares	34,893
Ending balance | shares	321,054
Beginning balance | $ / shares	$ 4.77
Granted | $ / shares	7.11
Ending balance | $ / shares	$ 5.03

Stock-Based Compensation - Sc_4

Stock-Based Compensation - Schedule of Stock-based Compensation Expense Recorded in Operating Expenses (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation in operating expenses	$ 1,091	$ 961
Selling, General and Administrative [Member]
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation in operating expenses	962	862
Research and Development [Member]
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation in operating expenses	$ 129	$ 99

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation	$ 1,169	$ 1,047
Weighted Average Remaining Life (in years)	1 year 6 months
Stock Options [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation	$ 100	$ 100
Unrecognized compensation expense for stock options issued	$ 900
Weighted Average Remaining Life (in years)	6 years 5 months 4 days
Restricted Stock Units (RSUs) [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation expense for stock options issued	$ 500
Weighted-average recognized period	1 year 10 months 24 days
Restricted Stock Awards (RSAs) [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation expense for stock options issued	$ 1,300
Weighted-average recognized period	2 years 3 months 18 days

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($)	Jan. 19, 2021	Dec. 28, 2020	Apr. 30, 2021	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Other Commitments [Line Items]
Audit committee findings				The primary investigative findings were: (i) the DABRA catheter frequently failed to calibrate and occasionally overheated, posing a risk of injury to physicians and patients; (ii) the Company’s explanations regarding its fourth quarter 2018 and first quarter 2019 sales created a risk of confusion because they did not explicitly reference inconsistent DABRA catheter performance and catheter failures; (iii) the Company failed to timely make at least two Medical Device Reports, or MDRs, to the FDA; (iv) the Company, out of a concern for the DABRA catheters’ performance, engaged in systematic efforts to replace product held by customers, which constituted product recalls, but were not documented as such, (v) the Company lack documentation of sufficient detail and specificity to support certain payments to physicians, ostensibly for training and consulting services, and as to three physicians did not accurately reflect the purpose and nature of approximately $300,000 of payments, which could be perceived as an improper attempt to obtain business or to gain special advantage, (vi) while the indication for use in the 510(k) clearance the Company obtained for the DABRA system is not for atherectomy, the Company’s salespeople were instructed to characterize DABRA as performing atherectomy and to encourage doctors to seek reimbursement using atherectomy codes, (vii) the Company’s determinations to direct potentially valuable benefits and opportunities to doctors were informed in part by sales prospects, and (viii) the Company received complaints regarding regulatory or compliance concerns that, because they implicated executive officers, should have been brought to the attention of the Board or the Audit Committee, but were not.
Payments to physicians that lack documentation of sufficient detail				$ 300,000
Revenue				$ 1,118,000	$ 1,374,000
Settlement Agreement [Member]
Other Commitments [Line Items]
Allegations description				(a) paid illegal remuneration to certain physicians to induce them to use the DABRA laser system in violation of the federal anti-kickback statute and (b) marketed the DABRA laser system for off-label use in atherectomy procedures despite product performance issues causing calibration and overheating problems, which posed a risk to physicians and patients (the “Covered Conduct”).
Litigation settlement amount						$ 2,500,000
Payment for legal settlement						2,400,000
Settlement amount , year 2021		$ 500,000
Settlement year one		2021
Settlement amount , year 2022		$ 750,000
Settlement year two		2022
Settlement amount , year 2023		$ 1,000,000
Settlement year three		2023
Settlement amount , year 2024		$ 1,250,000
Settlement year four		2024
Business acquisition, settlement amount		$ 5,000,000
Business acquisition additional settlement percentage		4.00%
Business acquisition, transaction costs		$ 100,000,000
Business acquisition change In control payments		28,000,000
Settlement claim		56,000,000
Settlement expense		200,000
Loss contingency, payments						$ 2,700,000
Settlement accrued expenses				$ 100,000
Settlement Agreement [Member] | Subsequent Event [Member]
Other Commitments [Line Items]
Payment for legal settlement			$ 100,000
Settlement Agreement [Member] | Maximum [Member]
Other Commitments [Line Items]
Litigation settlement amount	$ 265,000
Revenue		$ 10,000,000
Integrity Agreement [Member]
Other Commitments [Line Items]
Agreement term				5 years

Segment Information - Additiona

Segment Information - Additional Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)Segment	Mar. 31, 2020	Dec. 31, 2020USD ($)
Segment Reporting Information [Line Items]
Number of operating segments | Segment	2
Property and equipment, net	$ 2,820		$ 3,211
Revenue from Contract with Customer Benchmark [Member] | Customer Concentration Risk [Member]
Segment Reporting Information [Line Items]
Concentration risk, percentage	10.00%	10.00%
Vascular [Member]
Segment Reporting Information [Line Items]
Property and equipment, net	$ 1,700		1,900
Dermatology [Member]
Segment Reporting Information [Line Items]
Property and equipment, net	$ 500		$ 700

Segment Information - Summary o

Segment Information - Summary of Segment Performance (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Segment Reporting Information [Line Items]
Net revenue	$ 1,118	$ 1,374
Cost of revenue	1,373	1,584
Gross loss	(255)	(210)
Vascular [Member]
Segment Reporting Information [Line Items]
Net revenue	4	113
Cost of revenue	399	661
Gross loss	(395)	(548)
Dermatology [Member]
Segment Reporting Information [Line Items]
Net revenue	1,114	1,261
Cost of revenue	974	923
Gross loss	$ 140	$ 338

Segment Information - Summary_2

Segment Information - Summary of Net Revenue Classified by Major Geographic Areas (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenues From External Customers And Long Lived Assets [Line Items]
Net revenue	$ 1,118	$ 1,374
United States [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net revenue	1,063	1,186
All other countries [Member]
Revenues From External Customers And Long Lived Assets [Line Items]
Net revenue	$ 55	$ 188