UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
WASHINGTON,
D.C. 20549
FORM
10-K
(MARK
ONE)
FOR
THE FISCAL YEAR ENDED DECEMBER 31, 2025
OR
FOR
THE TRANSITION PERIOD FROM TO
COMMISSION
FILE NUMBER 001-36159
STEREOTAXIS,
INC.
(Exact
name of the Registrant as Specified in its Charter)
(State or Other Jurisdiction of (I.R.S. Employer
Incorporation or Organization) Identification Number)
710
North Tucker Boulevard, Suite 110
St.
Louis, MO63101
(Address
of Principal Executive Offices including Zip Code)
(314)678-6100
(Registrant’s
Telephone Number, Including Area Code)
Securities
registered pursuant to Section 12(b) of the Act:
Title of each class Trading Symbol(s) Name of each exchange on which registered
Common Stock, par value $0.001 per share STXS NYSE American
Securities
registered pursuant to Section 12(g) of the Act: None
Indicate
by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No ☒
Indicate
by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒
Indicate
by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange
Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2)
has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐
Indicate
by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule
405 of Regulation S-T “See 232.405 of this Chapter” during the preceding 12 months (or for such shorter period that the registrant
was required to submit such files). Yes ☒ No ☐
Indicate
by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting
company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”,
“smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Emerging growth company ☐
If
an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying
with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate
by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness
of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered
public accounting firm that prepared or issued its audit report. ☐
If
securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the consolidated financial statements
of the registrant included in the filing reflect the correction of an error to previously issued consolidated financial statements. ☐
Indicate
by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation
received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐
Indicate
by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes ☐ No ☒
The
aggregate market value of the registrant’s common stock held by non-affiliates of the registrant on the last business day of the
registrant’s most recently completed second fiscal quarter (based on the closing sales prices on the NYSE American on June 30,
2025) was approximately $150.3 million.
The
number of outstanding shares of the registrant’s common stock on February 28, 2026, was 97,248,936.
DOCUMENTS
INCORPORATED BY REFERENCE
Portions
of the Proxy Statement for the registrant’s 2026 Annual Meeting of Shareholders are incorporated by reference in Part III, Items
10, 11, 12, 13 and 14.
STEREOTAXIS,
INC.
INDEX
TO ANNUAL REPORT ON FORM 10-K
STEREOTAXIS,
INC.
INDEX
TO FORM 10-K
Page
Part I
Item 1. Business 3
Item 1A. Risk Factors 17
Item 1B. Unresolved Staff Comments 37
Item 1C. Cybersecurity 37
Item 2. Properties 38
Item 3. Legal Proceedings 39
Item 4. Mine Safety Disclosures 39
Part II
Item 6. [Reserved] 39
Item 8. Consolidated Financial Statements and Supplementary Detail 48
Item 9A. Controls and Procedures 74
Item 9B. Other Information 75
Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 75
PART III
Item 10. Directors and Executive Officers of the Registrant 75
Item 11. Executive Compensation 76
Item 14. Principal Accounting Fees and Services 76
PART IV
Item 15. Exhibits and Consolidated Financial Statement Schedules 76
PART
I
ITEM 1. BUSINESS
In
this report, “Stereotaxis”, the “Company”, “Registrant”, “we”, “us”, and
“our” refer to Stereotaxis, Inc. and its wholly owned subsidiaries. GenesisX RMN®, Genesis RMN®,
Niobe®, Navigant®, SynchronyTM, SynXTM, Odyssey®, Odyssey CinemaTM,
MAGiCTM, MAGiC SweepTM, EMAGINTM, Map-iTTM, QuikCASTM, Cardiodrive®, Vdrive®,
Vdrive DuoTM, V-CASTM, V-LoopTM, V-SonoTM, and NuVizionTM are trademarks of
Stereotaxis, Inc. All other trademarks that appear in this report are the property of their respective owners.
FORWARD-LOOKING
STATEMENTS
This
annual report on Form 10-K, including the sections entitled “Business” and “Management’s Discussion and Analysis
of Financial Condition and Results of Operations,” contains forward-looking statements. These statements relate to, among other
things:
● our business, operating, sales and marketing, and regulatory strategies;
● our value proposition;
● our overall liquidity and our ability to fund operations;
● our ability to convert backlog to revenue;
● the adoption of our products by hospitals and physicians;
● the success of our business partnerships and strategic relationships;
● our industry generally, and overall macroeconomic conditions;
● our estimates regarding our capital requirements;
● our plans for hiring additional personnel; and
These
statements relate to future events or future financial performance, and involve known and unknown risks, uncertainties, and other factors
that may cause our actual results, levels of activity, performance or achievements to be materially different from any future results,
levels of activity, performance or achievements expressed or implied by such forward-looking statements. In some cases, you can identify
forward-looking statements by terminology such as “may”, “will”, “should”, “could”, “expects”,
“plans”, “intends”, “anticipates”, “believes”, “estimates”, “predicts”,
“potential”, or “continue”, or the negative of such terms or other comparable terminology. Although we believe
that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, levels of activity,
performance, or achievements. These statements are only predictions.
Factors
that may cause our actual results to differ materially from our forward-looking statements include, among others, changes in general
economic and business conditions and the risks and other factors set forth in “Item 1A—Risk Factors” and elsewhere
in this annual report on Form 10-K.
Our
actual results may be materially different from what we expect. We undertake no duty to update these forward-looking statements after
the date of this annual report, even though our situation may change in the future. All of our forward-looking statements are qualified
by these cautionary statements.
OVERVIEW
Stereotaxis
designs, manufactures and markets robotic systems, instruments and information systems for the interventional laboratory. Our proprietary
robotic technology, Robotic Magnetic Navigation, fundamentally transforms endovascular interventions using precise computer-controlled
magnetic fields to directly control the tip of flexible interventional catheters or devices. Direct control of the tip of an interventional
device, in contrast to all manual hand-held devices that are controlled from their handle, can improve the precision, stability, reach
and safety of these devices during procedures.
Our
primary clinical focus has been electrophysiology, specifically cardiac ablation procedures for the treatment of arrhythmias. Cardiac
ablation has become a well-accepted therapy for arrhythmias and a multi-billion-dollar medical device market with expectations for substantial
long-term growth. We have shared our aspirations and a product strategy to expand the clinical focus of our technology to several additional
endovascular indications including coronary, neuro, and peripheral interventions.
There
is substantial real-world evidence and clinical literature for Robotic Magnetic Navigation in electrophysiology. Hundreds of electrophysiologists
at over one hundred hospitals globally have treated over 150,000 arrhythmia patients with our robotic technology. Clinical use of our
technology has been documented in over 500 clinical publications. Robotic Magnetic Navigation is designed to enable physicians to complete
more complex interventional procedures with greater success and safety by providing image-guided delivery of catheters through the blood
vessels and chambers of the heart to treatment sites. This is achieved using externally applied computer-controlled magnetic fields that
govern the motion of the working tip of the catheter, resulting in improved navigation. The more flexible atraumatic design of catheters
driven using magnetic fields may reduce the risk of patient harm and other adverse events. Performing the procedure from a control cockpit
enables physicians to complete procedures in a safe location protected from x-ray exposure, with greater ergonomics, and improved efficiency.
We believe these benefits can be applicable in other endovascular indications where navigation through complex vasculature is often challenging
or unsuccessful and generates significant x-ray exposure, and we are investing in research and development in these areas.
Our
primary products include the Genesis RMN and the GenesisX RMN Systems, the Odyssey and Synchrony & SynX Solutions,
various interventional devices under the Map-iT, MAGiC and EMAGIN brands, and other related devices. Through our
strategic relationships with fluoroscopy system manufacturers, providers of catheters and electrophysiology mapping systems, and other
parties, we offer our customers x-ray systems and other accessory diagnostic and therapeutic devices.
The Genesis
RMN and the GenesisX RMN Systems are designed to enable physicians to complete complex interventional procedures by
providing image-guided delivery of catheters through the blood vessels and chambers of the heart to treatment sites. This is
achieved using externally applied magnetic fields that govern the motion of the working tip of the catheter, resulting in improved
navigation, efficient procedures, and reduced x-ray exposure. The GenesisX RMN System, the latest generation of the Genesis
RMN System, is designed to enhance the accessibility of Robotic Magnetic Navigation by reducing the lengthy construction cycle
necessary to install prior generation RMN systems.
The
Odyssey Solution consolidates lab information onto one large integrated display, enabling physicians to view and control all the
key information in the operating room. This is designed to improve lab layout and procedure efficiency. The system also features a remote
viewing and recording capability called Odyssey Cinema. The Odyssey Solution and Odyssey Cinema are being replaced
by next generation innovative solutions branded Synchrony and SynX. Synchrony digitizes and modernizes the interventional
cath lab with a 4K high-definition display that consolidates the viewing and control of disparate systems in the lab, offering enhanced
procedure experience with custom layouts, streamlined workflows, an intuitive user interface, and a decluttered environment. Synchrony
is made available with SynX a cloud-based HIPAA and GDPR-compliant browser and mobile-based app that allows for secure remote
connectivity, collaboration, recording, and monitoring of the cath lab. As these technologies gain regulatory approvals they are being
commercialized alongside RMN systems and as stand-alone solutions.
We
pursue arrangements with fluoroscopy system manufacturers to provide RMN Systems in a bundled purchase offer for hospitals establishing
robotic interventional operating rooms. An integrated x-ray system is critical for customer adoption of RMN Systems, and when
offered as a bundled purchase with the RMN System, it may reduce the cost of acquisition, the ongoing cost of ownership, and the
complexity of installation of a robotic electrophysiology practice.
We
promote our full suite of products necessary for a typical hospital implementation, subject to regulatory approvals or clearances. This
implementation requires a hospital to agree to an upfront capital payment and recurring payments. The upfront capital payment typically
includes equipment and installation charges. The recurring payments typically include disposable costs for each procedure, equipment
service costs beyond the warranty period, and ongoing software updates. In hospitals where our full suite of products has not been implemented,
equipment upgrade or expansion can be implemented upon purchasing of the necessary upgrade or expansion.
As
of December 31, 2025, we had approximately $9.1 million of system backlog, consisting of outstanding purchase orders and other commitments
for these systems. Of the December 31, 2026 backlog, we expect approximately 78% to be recognized as revenue over the course of 2026.
We had system backlog of approximately $14.4 million as of December 31, 2024. There can be no assurance that we will recognize such revenue
in any period or at all because some of our purchase orders and other commitments are subject to contingencies that are outside our control.
These orders and commitments may be revised, modified or canceled, either by their express terms, because of negotiations or by project
changes or delays. In addition, the sales cycle for the robotic magnetic navigation system is lengthy and generally involves construction
or renovation activities at customer sites. Consequently, revenues and/or orders resulting from sales of our robotic magnetic navigation
system can vary significantly from one reporting period to the next.
We
have strategic relationships with technology leaders and innovators in the global interventional market. Through these strategic relationships
we provide compatibility with our robotic magnetic navigation system, integrated x-ray systems, digital imaging and 3D catheter location
sensing technology, and compatible disposable interventional devices. The maintenance of these strategic relationships, or the establishment
of equivalent alternatives, is critical to our commercialization efforts. There are no guarantees that any existing strategic relationships
will continue, and efforts are ongoing to ensure the availability of compatible systems and devices and/or equivalent alternatives. We
cannot provide assurance as to the timeline of the ongoing availability of such compatible systems or our ability to obtain equivalent
alternatives on competitive terms or at all.
On
July 31, 2024, the Company completed its acquisition of all the shares of capital stock of Access Point Technologies EP, Inc., a Minnesota
corporation (“APT”), from APT Holding Company, Inc., a Minnesota corporation. APT, based in Rogers, Minnesota, designs, manufactures,
and commercializes a portfolio of differentiated high-quality diagnostic catheters, branded as Map-iT catheters, used during cardiac
ablation procedures that are commercially available across key global geographies.
The
integration with APT provides in-house catheter development, manufacturing expertise and specialized knowledge that will further Stereotaxis’
innovation efforts in developing a broad family of interventional devices navigated by our robots within electrophysiology and across
a range of endovascular procedures.
We
were incorporated in Delaware in June of 1990 as Stereotaxis, Inc. Our principal executive offices are located at 710 North Tucker Boulevard,
Suite 110, St. Louis, Missouri 63101, and our telephone number is (314) 678-6100.
We operate our business as one
segment, as defined by U.S. generally accepted accounting principles. Our financial results for the years ended December 31, 2025
and 2024 are discussed in “Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations”.
THE
STEREOTAXIS VALUE PROPOSITION
Although
great strides have been made in manual interventional devices and techniques, significant challenges remain that reduce interventional
productivity and limit both the number of complex procedures and the types of diseases that can be treated manually. These challenges
primarily involve the inherent mechanical limitations of manual instrument control and the lack of integration of the information systems
used by physicians in the interventional lab as well as a significant amount of training and experience required to ensure proficiency.
As a result, many complex cases in electrophysiology are treated with palliative drug therapy, and many procedures are still performed
as invasive surgeries rather than as minimally invasive endovascular interventions.
Our
systems address the current challenges in the interventional lab by providing precise computerized control of the working tip of the
interventional instrument and by integrating this control with the visualization technology and information systems used during electrophysiology
and endovascular interventional procedures, on a cost-justified basis.
We
believe that our technology can:
PRODUCTS
Robotic
Magnetic Navigation
Our
proprietary robotic magnetic navigation systems (“RMN”) include the GenesisX RMN, Genesis RMN and the prior generation
Niobe Systems. These systems are designed to enable physicians to complete more complex interventional procedures by providing
image-guided delivery of catheters and guidewires through the blood vessels and chambers of the heart to treatment sites. This is achieved
using externally applied magnetic fields that govern the motion of the working tip of the catheter or guidewire, resulting in improved
navigation, efficient procedures and reduced x-ray exposure. Our systems provide physicians with precise remote digital instrument control
in combination with sophisticated image integration. It can be operated either from an adjacent room and outside the x-ray fluoroscopy
field or beside the patient table, as in traditional interventional procedures. Our RMN system allows the operator to navigate disposable
interventional devices to the treatment site through complex paths in the blood vessels and chambers of the heart to deliver treatment
by using computer controlled, externally applied magnetic fields to directly govern the motion of the working tip of these devices, each
of which has a magnetically sensitive tip that predictably responds to magnetic fields generated by our system. Because the working tip
of the disposable interventional device is directly controlled by these external magnetic fields, the physician has the same degree of
control regardless of the number or type of turns, or the distance traveled by the working tip to arrive at its position in the blood
vessels or chambers of the heart. This results in highly precise digital control of the working tip of the disposable interventional
device while still giving the physician the option to manually advance the device.
Through
our arrangements with manufacturers and providers of fluoroscopy systems, catheters, and electrophysiology mapping systems, we provide
compatibility between the robotic magnetic navigation system and the visualization and information systems used during electrophysiology
and endovascular procedures to provide the physician with a comprehensive information and instrument control system. In addition, we
have integrated the robotic magnetic navigation system with 3D catheter location sensing technology to provide accurate real-time information
as to the 3D location of the working tip of the instrument. The maintenance of these technology compatibility, integrations, and strategic
relationships is critical to our commercialization efforts. There are no guarantees that any existing strategic relationships will continue,
and efforts are ongoing to ensure the availability of compatible systems and devices and/or equivalent alternatives.
Our
robotic magnetic navigation systems utilize two permanent magnets mounted on articulating and pivoting arms with one magnet on either
side of the patient table. These magnets generate magnetic navigation fields that steer and deflect the magnetic interventional devices
in the patient anatomy. These magnetic fields are significantly less than the strength of fields typically generated by MRI equipment.
The robotic magnetic navigation system is indicated for use in cardiac, peripheral and neurovascular applications. The robotic magnetic
navigation system is used in conjunction with the Cardiodrive Automated Catheter Advancement System (“Cardiodrive”)
and the QuikCAS automated catheter advancement single-use disposable device, which together are used to remotely advance and retract
a catheter while the robotic magnetic navigation system magnets steer the working tip of the device.
Odyssey®
Solution
The
Odyssey Solution, and the next generation, Synchrony and SynX Solution, offer a fully integrated, real-time information
solution to manage, control, record and share procedures across networks or around the world. We believe that these tools enhance the
physician workflow in interventional labs through a consolidated user interface of multiple systems on a single display to enable greater
focus on the case and improve the efficiency of the lab. Using a single mouse and keyboard, the Odyssey Solution allows the user
to command multiple systems in the lab from a single point of control. In addition, the Odyssey Solution acquires a real-time,
remote view of the lab, capturing synchronized procedure data for review of important events during cases. The Odyssey Solution
enables physicians to access recorded cases and creates snapshots following procedures for enhanced clinical reporting, auditing and
presentation. The Odyssey Solution enables physicians to establish a comprehensive master archive of procedures performed in the
lab providing an excellent tool for training new staff on standard practices. The Odyssey Solution further enables procedures
to be observed remotely around the world with high-speed Internet access over a hospital VPN, even wirelessly using a standard laptop
or Windows tablet computer. The next generation solution, branded as Synchrony and SynX, modernizes the interventional
cath lab with a 4K high-definition display that consolidates the viewing and control of disparate systems in the lab, offering enhanced
procedure experience with custom layouts, streamlined workflows, an intuitive user interface, and a decluttered environment. SynchronyTM
is made available with SynXTM, a cloud-based HIPAA and GDPR-compliant browser and mobile-based app that allows for secure remote
connectivity, collaboration, recording, and monitoring of the cath lab.
X-ray
systems
We
pursue arrangements with fluoroscopy system manufacturers to provide such systems in a bundled purchase offer for hospitals establishing
robotic interventional operating rooms. An integrated x-ray system is critical for customer adoption of RMN systems, and when offered
as a bundled purchase offer with the RMN System, may reduce the cost of acquisition, the ongoing cost of ownership, and the complexity
of installation of a robotic electrophysiology practice.
Disposables
and Other Accessories
Our
robotic magnetic navigation systems are designed to use a toolkit of associated disposable interventional devices. We market and distribute
disposable and related devices that can be used with our robotic magnetic navigation systems and in traditional, manual procedures.
Within
the robotic device toolkit, we manufacture and distribute the MAGiC catheter, the MAGiC Sweep mapping catheter, the QuikCAS,
the iCONNECT, and the V-CAS devices.
Prior
to regulatory clearance of a replacement device, our propriety MAGiC ablation catheter, in Europe in 2025 and regulatory approval
in the U.S. in early 2026, the robotically enabled ablation catheters predominantly used with our RMN Systems were co-developed with
Biosense Webster, a wholly owned subsidiary of Johnson and Johnson (the “J&J catheters”). The J&J catheters were
solely manufactured and distributed by them and their obligation to supply those catheters ended on December 31, 2025. We do not know
their plans for the continuation of the J&J catheters, and we have no guarantees that supply of those catheters will continue into
2026. Although we are ramping up production of the MAGiC ablation catheter as a replacement device, continued supply of the J&J
catheters into 2026 remains of significant importance for many customers of our technology.
On
July 31, 2024, the Company completed its acquisition of Access Point Technologies EP, Inc, based in Rogers, Minnesota providing us with
the Map-iT portfolio of devices. These devices include differentiated high-quality diagnostic catheters used in traditional cardiac
ablation procedures and are commercially available across key global geographies. The acquisition also provides us with the basis to
develop additional magnetically enabled devices which can be used with our RMN systems.
Revenue
from sales of disposable products is recognized when control is transferred to the customers, which generally occurs at the time of shipment,
but can also occur at the time of delivery depending on the customer arrangement. Disposable products are covered by an assurance-type
warranty that provides for the return of defective products. Warranty costs were not material for the periods presented.
The
maintenance of strategic relationships with compatible devices, or the establishment of equivalent alternatives, is critical to our commercialization
efforts. There are no guarantees that any existing strategic relationships will continue, and efforts are ongoing to ensure the availability
of compatible devices and/or equivalent alternatives. We cannot provide any assurance as to the timeline of the ongoing availability
of such compatible systems or our ability to obtain equivalent alternatives on competitive terms or at all.
Other
Recurring Revenue
Other
recurring revenue includes revenue from product maintenance plans, service-type warranties, and other post warranty maintenance. Revenue
from services and software enhancements, including service-type warranties, are deferred and amortized over the service or update period,
which is typically one year. Revenue related to services performed on a time-and-materials basis is recognized when performed.
Regulatory
Approval
We
have received regulatory clearance, and/or approvals necessary for us to market the Genesis System with Cardiodrive, iCONNECT, Navigant,
Odyssey and QuikCAS in the U.S., Europe, and China, and we are in the process of pursuing registrations for extending our markets
in other countries.
We
have received regulatory clearance, and/or approvals necessary for us to market the GenesisX RMN System, the latest generation
of the Genesis RMN System in the U.S. and Europe, and we are in the process of obtaining necessary approvals in other countries.
We
have regulatory clearances and approvals that allow us to market the SynX collaboration solution in the U.S. and Europe.
We
have obtained the CE marking for us to market the Synchrony system in Europe and are in the process of obtaining necessary approvals
in the US and other countries.
We
have received regulatory clearance, and/or approvals necessary for us to market the Niobe System with Cardiodrive, e-Contact, Navigant,
Odyssey, QuikCAS in the U.S., Europe, Canada, China, Japan, and various other countries.
We
have received regulatory clearance, licensing and/or approvals necessary for us to market the Vdrive and Vdrive Duo Systems with
the V-CAS in the U.S., Europe, and Canada.
We
have received regulatory clearance, licensing and/or approvals necessary for us to market the Stereotaxis MAGiC catheter, a robotically
navigated magnetic ablation catheter designed to perform minimally invasive cardiac ablation procedures in the U.S. and Europe, and we
are in the process of obtaining necessary approvals in other countries.
We
have received regulatory clearance and/or approvals necessary for us to market the Map-it diagnostic mapping catheters in the U.S. and
Europe.
The
MAGiC SweepTM catheter, the first robotically navigated high-density EP mapping catheter, received FDA 510(k) clearance in
July 2025. We are in the process of obtaining necessary approvals in other geographies.
We
are also currently seeking regulatory clearances for the EMAGIN 5F catheter guide designed to robotically navigate tortuous venous
and arterial vasculature.
FINANCIAL
INFORMATION ABOUT CUSTOMERS
No
single customer accounted for more than 10% of total revenue for the years ended December 31, 2025 and 2024. No single country, other
than the U.S., accounted for more than 10% of total revenue for the years ended December 31, 2025, and 2024.
CLINICAL
APPLICATIONS
We
have focused our clinical and commercial efforts on applications of our products primarily in electrophysiology procedures for the treatment
of arrhythmias and secondarily in complex interventional cardiology procedures for the treatment of coronary artery disease. Our system
potentially has broad applicability in other areas, such as structural heart repair, interventional neurosurgery, interventional neuroradiology,
peripheral vascular, renal denervation, pulmonology, urology, gynecology and gastrointestinal medicine, and some of our patents may be
applicable in these areas as well.
Electrophysiology
The
rhythmic beating of the heart results from the transmission of electrical impulses. When these electrical impulses are mistimed or uncoordinated,
the heart fails to function properly, resulting in symptoms that can range from fatigue to stroke or death. Over 5.0 million people in
the U.S. currently suffer from abnormal heart rhythms, which are known as arrhythmias. The prevalence of arrhythmias is expected to continue
to rise as the population ages, life expectancy increases, and lifestyle factors such as obesity become more prevalent. Arrhythmias are
a major physical and economic burden and are associated with stroke, heart failure, and adverse symptoms causing patients to be motivated
to seek treatment. The combination of symptoms, prevalence and comorbidities make arrhythmias a major economic factor in healthcare.
Drug
therapies for arrhythmias often have limited efficacy, poor compliance, and side effects. Consequently, physicians have increasingly
sought more permanent, non-pharmacological, solutions for arrhythmias. The most common interventional treatment for arrhythmias is an
ablation procedure in which the diseased tissue giving rise to the arrhythmia is isolated or destroyed. Prior to performing an electrophysiology
ablation, a physician typically performs a diagnostic procedure in which the electrical signal patterns of the heart wall are “mapped”
to identify the heart tissue generating the aberrant electrical signals. Following the mapping, the physician may then use an ablation
catheter to eliminate the aberrant signal or signal path, restoring the heart to its normal rhythm. These procedures may be performed
separately but are more commonly performed at the same time.
We
believe more than 7,000 interventional labs around the world are currently conducting nearly one and a half million cardiac ablation
procedures annually. The market has grown rapidly over the last decade with annualized procedure growth of approximately 10%.
We
believe that Robotic Magnetic Navigation is particularly well-suited for these electrophysiology procedures which are time consuming,
or which can only be performed by highly experienced physicians. These procedures include:
We
believe that our RMN can address the current challenges in electrophysiology by permitting the physician to remotely navigate disposable
interventional devices from a control room outside the x-ray field. Additionally, we believe that our RMN allows for more predictable
and efficient navigation of these devices to the treatment site and enables catheter contact to be consistently maintained to efficiently
apply energy on the wall of the beating heart. We also believe that our RMN will significantly lower the skill barriers required for
physicians to perform complex electrophysiology procedures and, additionally, improve interventional lab efficiency and reduce disposable
interventional device utilization.
Interventional
Cardiology
More
than half a million people die annually from coronary artery disease, a condition in which the formation of plaque in the coronary arteries
obstructs the supply of blood to the heart, making this the leading cause of death in the U.S. Despite various attempts to reduce risk
factors, each year over one million patients undergo interventional procedures in an attempt to open blocked vessels and another one
half million patients undergo open heart surgery to bypass blocked coronary arteries.
Blockages
within a coronary artery, often called lesions, are categorized by degree of obstruction as partial occlusions, non-chronic total occlusions
and chronic total occlusions. Lesions are also categorized by the degree of difficulty with which they can be opened as simple or complex.
Complex lesions, such as chronic total occlusions, longer lesions, and lesions located within smaller diameter vessels, are often very
difficult or time consuming to open with manual interventional techniques.
We
believe approximately 11,000 interventional labs worldwide are currently capable of conducting interventional cardiology. Over 4 million
interventional cardiology procedures are performed annually in the U.S. alone. We estimate that approximately 10-15% of these interventional
cardiology procedures currently being performed are complex and therefore require longer procedure times and may have sub-optimal outcomes.
We believe that our system can substantially benefit this subset of complex interventional cardiology procedures.
Interventional
Neuroradiology, Neurosurgery and Other Interventional Applications
Physicians
used a predecessor to our Niobe System to conduct a number of procedures for the treatment of brain aneurysms, a condition in
which a portion of a blood vessel wall balloons and which can result in debilitating or fatal bleeding and strokes. We believe the robotic
magnetic navigation system also has a range of potential applications in minimally invasive neurosurgery, including biopsies and the
treatment of tumors, treatment of vascular malformations and fetal interventions.
STRATEGIC
RELATIONSHIPS
We
have arrangements with technology leaders in the global interventional market, including manufacturers of fluoroscopy systems, ablation
catheters, and electrophysiology mapping systems, that we believe are critical for us in commercializing our robotic magnetic navigation
systems. These arrangements are important to us as they provide for the integration of our system with digital imaging and 3D catheter
location sensing technology, as well as catheters compatible with our system.
With
partners, we jointly developed electrophysiology mapping and ablation catheters that are navigable with our robotic magnetic navigation
system. We believe that these products provide physicians with the elements required for effective complex electrophysiology procedures:
accurate information as to the location of the catheter in the body and precise control over the working tip of the catheter.
Prior
to regulatory clearance of a replacement device, our propriety MAGiC ablation catheter, in Europe in 2025 and regulatory approval
in the U.S. in early 2026, the robotically enabled ablation catheters predominantly used with our RMN Systems were co-developed
with Biosense Webster, a wholly owned subsidiary of Johnson and Johnson (the “J&J catheters”). The J&J catheters
were solely manufactured and distributed by them and their obligation to supply those catheters ended on December 31, 2025. We do not
know their plans for the continuation of the J&J catheters, and we have no guarantees that supply of those catheters will continue
into 2026. Although we are ramping up production of the MAGiC ablation catheter as a replacement device, continued supply of the
J&J catheters into 2026 remains of significant importance for some customers of our technology.
The
maintenance of strategic relationships with technology leaders in the global interventional market, or the establishment of equivalent
alternatives, is critical to our commercialization efforts. There are no guarantees that any existing strategic relationships will continue,
and efforts are ongoing to ensure the availability of compatible systems and devices and/or equivalent alternatives. We cannot provide
any assurance as to the timeline of the ongoing availability of such compatible systems or our ability to obtain equivalent alternatives
on competitive terms or at all.
RESEARCH
AND DEVELOPMENT
We
have assembled an experienced group of engineers and physicists with recognized expertise in magnetics, software, control algorithms,
mechanics, electronics, systems integration and disposable interventional device design.
Our
research and development efforts are focused in the following areas:
● development and enhancement of Robotic Magnetic Navigation Systems;
Our
research and development team collaborates with strategic third parties to integrate our robotic magnetic navigation system’s open
architecture platform with key imaging, location sensing and information systems in the interventional lab. We have also collaborated
with highly regarded interventional physicians in key clinical areas and have entered into agreements with universities and teaching
hospitals, which serve to increase our access to world class physicians and to expand our name recognition in the medical community.
CUSTOMER
SERVICE AND SUPPORT
We
provide worldwide maintenance and support services to our customers’ products directly or with the assistance of outsourced product
and service representatives. By utilizing these relationships, we provide direct, on-site technical support activities, including call
center, customer support engineers and service parts logistics and delivery. In certain situations, we use these third parties as a single
point of contact for the customer, allowing us to focus on providing installation, training and back-up technical support.
Our
back-up technical support includes a combination of on-line, telephone and on-site technical assistance services 24 hours a day, seven
days a week. We employ service and support engineers with networking and medical equipment expertise and outsource a portion of our installation
and support services. We offer different levels of support to our customers, including basic hardware and software maintenance, extended
product maintenance, and rapid response capability for both parts and service.
We
have established a call center in our St. Louis facilities, which provides real-time clinical and technical support to our customers
worldwide.
MANUFACTURING
Robotic
Magnetic Navigation Systems and Odyssey and Synchrony & SynX Solutions
Our
manufacturing strategy for our Robotic Magnetic Navigation Systems and Odyssey and Synchrony & SynX Solutions
is to sub-contract many of the manufacture of major subassemblies of our systems to maximize manufacturing flexibility and lower fixed
costs. We maintain quality control for all our systems by completing final system assembly and inspection in-house.
We
purchase both custom and off-the-shelf components from many suppliers and subject them to quality specifications and processes. Some
of the components necessary for the assembly of our products are currently provided to us by sole-sourced suppliers (the only recognized
supply source available to us) or single-sourced suppliers (the only approved supply source for us among other sources). We purchase
most of our components and major assemblies through purchase orders rather than long-term supply agreements and generally do not maintain
large volumes of finished goods.
Disposable
Interventional Devices
Our
historical manufacturing strategy for disposable interventional devices was to outsource their manufacture through subcontracting and
to expand partnerships for other interventional devices. We work closely with our contract manufacturers and have strong relationships
with component suppliers. We have entered into manufacturing agreements to provide high volume capability for devices other than catheters.
With the July of 2024 acquisition of APT, we have the ability to manufacture disposable interventional devices at our Rogers, Minnesota
location as a complement to our primarily outsourced model.
Software
The
software components of the robotic magnetic navigation system and the Odyssey and Synchrony & SynX Solutions , including
control and application software, are developed both internally and with integrated modules we purchase or license. We perform final
testing of software products in-house prior to their commercial release.
General
Our
manufacturing facility operates under processes that meet the FDA’s requirements under the Quality System Regulation (QSR). Our
ISO registrar and European notified British Standard Institution (BSI) has audited our facility annually since 2001 and found the facility
to comply with relevant requirements. The most recent ISO 13485 and MDSAP Certificate of Registration were issued in 2025 and are valid
through September 2028.
SALES
AND MARKETING
We
market our products in the U.S and internationally through a direct sales force of senior sales specialists, distributors and sales agents,
supported by account managers and clinical specialists who provide training, clinical support, and other services to our customers.
Our
sales and marketing efforts include two important elements: (1) selling robotic magnetic systems, the Odyssey and Synchrony
& SynX Solutions, and magnetically compatible x-ray systems directly and through distributors; and (2) leveraging our
installed base of systems to drive recurring sales of disposable interventional devices, software and service.
REIMBURSEMENT
We
believe that substantially all of the procedures, whether commercial or in clinical trials, conducted in the U.S. with the robotic magnetic
navigation systems have been reimbursed to date. We expect that third-party payors will reimburse, under existing billing codes, procedures
in which compatible ablation catheters are used. We expect healthcare facilities in the U.S. to bill various third-party payors, such
as Medicare, Medicaid, other government programs and private insurers, for services performed with our products. We believe that procedures
performed using our products or targeted for use by products that do not yet have regulatory clearance or approval, are generally already
reimbursable under government programs and most private plans. Accordingly, we believe providers in the U.S. will generally not be required
to obtain new billing authorizations or codes to be compensated for performing medically necessary procedures using our products on insured
patients. We cannot guarantee that reimbursement policies of third-party payors will not change in the future with respect to some or
all of the procedures using the robotic magnetic navigation system.
In
countries outside the United States, reimbursement is obtained from various sources, including governmental authorities, private health
insurance plans, and labor unions. In most foreign countries, private insurance systems may also offer payments for some therapies. Additionally,
health maintenance organizations are emerging in certain European countries. In Europe, we believe that substantially all of the procedures,
whether in commercial settings or clinical trials, conducted with the robotic magnetic navigation systems have been reimbursed to date.
In other foreign countries, we may need to seek international reimbursement approvals, and we do not know if these required approvals
will be obtained in a timely manner or at all.
See
“Item 1A—Risk Factors” for a discussion of various risks associated with reimbursement from third-party payors.
INTELLECTUAL
PROPERTY
The
proprietary nature of, and protection for, our products, processes and know-how are important to our business. We seek patent protection
in the United States and internationally for our systems and other technology where available and when appropriate.
We
have an extensive patent portfolio that we believe protects the fundamental scope of our technology and systems, including our robotic
magnetic technology, navigational methods, mapping system and procedural workflows, 3D integration technology, and disposable interventional
devices. As of December 31, 2025, we had 43 issued U.S. patents and 3 pending U.S. patent application. In addition, we had 6 issued foreign
patents and 5 pending foreign patent applications. The key patents that protect our technology and systems extend until 2028 and beyond.
We
also have a number of invention disclosures under consideration and several applications that are being prepared for filing. We cannot
be certain that any patents will be issued from any of our pending patent applications, nor can we be certain that any of our existing
patents or any patents that may be granted in the future will provide us with protection.
We
believe it would be difficult and costly to reverse engineer our robotic magnetic navigation system, which contains numerous complex
algorithms that control our disposable devices inside the magnetic fields generated by the robotic magnetic navigation system. We further
believe that our patent portfolio is broad enough in scope to enable us to obtain legal relief if any entity not licensed by us attempted
to market disposable devices in the U.S. that can be navigated by the robotic magnetic navigation system. We can also utilize security
keys, such as embedded smart chips or associated software that could allow our system to recognize specific disposable interventional
devices to prevent unauthorized use of our system.
We
have also developed substantial expertise in magnet design, magnet physics, and magnetic instrument control in connection with the development
of the robotic magnetic navigation system, which we maintain as trade secrets. This expertise centers around our proprietary magnet design,
which is a critical aspect of our ability to design, manufacture and install a cost-effective magnetic navigation system that is small
enough to be installed in a standard interventional lab. Our Odyssey Solution contains numerous complex algorithms and proprietary
software and hardware configurations, and requires substantial knowledge to design and assemble, which we maintain as trade secrets.
This proprietary software and hardware, some of which is owned by Stereotaxis, and some of which is licensed to Stereotaxis, is a material
aspect of the ability to design, manufacture and install cost-effective and efficient information integration, storage, and delivery
platform.
In
addition, we seek to protect our proprietary information by entering confidentiality, assignment of inventions or license agreements
with our employees, consultants, contractors, advisers and other third parties. However, we believe that these measures afford only limited
protection.
COMPETITION
The
markets for medical devices are intensely competitive and are characterized by rapid technological advances, frequent new product introductions,