(Oslo, February 24, 2026) - Medistim ASA (OSE: MEDI), a leading niche provider
of ultrasound technology headquartered in Oslo, Norway, today announced the
commencement of SMARTFLOW, a randomized clinical trial (RCT) comparing the use
of Transit Time Flow Measurement (TTFM) with non-use in coronary artery bypass
graft (CABG) surgery. 

The SMARTFLOW trial is an expertise-based, multicenter, single-blind, randomized
study enrolling 1,242 patients across approximately 20 centers worldwide. Its
primary objective is to determine whether routine intraoperative assessment
using TTFM reduces early graft failure. The primary endpoint is graft failure
within 1 to 3 months after surgery, as assessed by coronary CT angiography
(CCTA). The trial is designed with the potential for extension to evaluate the
impact of TTFM on longer-term clinical outcomes, including myocardial
infarction, repeat revascularization, survival, and patient-reported quality of
life.

CABG remains the most commonly performed cardiac surgical procedure worldwide.
TTFM provides direct, real-time quantification of graft flow, allowing immediate
identification and correction of technical issues before chest closure.
Importantly, most graft failures occur within the first postoperative month and
are largely attributable to technical factors-such as kinking, overstretching,
competitive flow, or anastomotic errors-all of which are potentially preventable
through systematic intraoperative assessment. The TTFM technique is simple,
safe, and reproducible. However, high-quality evidence from randomized studies
of standardized intraoperative quality control with TTFM is limited.1)

The SMARTFLOW study will be led by Professor Mario Gaudino, MD, PhD, MSCE,
FEBCTS, FACC, FAHA, at Weill Cornell Medicine in New York, NY. In addition to
his numerous academic and clinical leadership roles, he serves as
Editor-in-Chief of The European Journal of Cardio-Thoracic Surgery. 

 "Most existing studies evaluating TTFM are small, observational, and
methodologically heterogeneous. Although expert consensus supports its use, the
lack of adequately powered randomized evidence remains a barrier to widespread
adoption in clinical practice," said Professor Gaudino. "In this context,
SMARTFLOW has been designed as the first appropriately powered randomized trial
to rigorously evaluate intraoperative graft assessment with TTFM in CABG. By
generating high-quality randomized data on the impact of TTFM on early graft
failure-and by providing a platform that can be extended to assess clinical
outcomes-the SMARTFLOW program has the potential to inform future guideline
recommendations and promote a more consistent, evidence-based approach to
intraoperative graft assessment."

Medistim is a global leader in intraoperative quality assessment and surgical
guidance in cardiac surgery, supporting approximately 40% of the more than
700,000 CABG procedures performed worldwide each year. Guided by its vision of
establishing TTFM as a standard of care in every operating room, the company has
achieved near-universal adoption in several regions, including Japan
(approximately 90%) as well as Central Europe and the Nordic countries (around
80%).

TTFM is endorsed in multiple professional guidelines, including the joint
recommendations of the European Association for Cardiothoracic Surgery (EACTS)
and the European Society of Cardiology (ESC). In the United States, however,
where adoption currently stands at approximately 40%, formal guideline
endorsement has not yet been established.

"Medistim's vision is to contribute to making CABG surgery safer, more
effective, and an increasingly attractive revascularization strategy for the
treatment of coronary artery disease-for the benefit of both patients and
surgeons alike. We are honored to support this landmark trial with our MiraQ
TTFM and High-Frequency Ultrasound (HFUS) technologies," said Kari E. Krogstad,
President and CEO of Medistim.
"A sufficiently powered randomized trial has long been awaited and has the
potential to provide the level of evidence needed to further accelerate
adoption."

Medistim is supporting the SMARTFLOW trial with USD 500,000 over the course of
the study.

1) Time to Assess the Role of Quality Control in CABG: The SMARTFLOW Trial
Program, Gaudino et al, European Journal of Cardio-Thoracic Surgery, Volume 67,
Issue 12, December 2025  

About Medistim:
Medistim was established in 1984 and has a track record of profitable growth
over the past 20 years. The company is a pioneer within its segment and
continues to invest in new product development. Medistim has wholly owned
subsidiaries with sales organizations in the USA, Canada, China, Germany, UK,
Spain, Denmark, Sweden and Norway, in addition to around 60 distributors in
Europe, Asia, Middle East, Africa, and South America.  Medistim is listed on the
Oslo stock exchange under the ticker OSE:MEDI.
For more information, visit the Medistim home page:  www.medistim.com 
For more information, contact: 

President and CEO, Kari E. Krogstad, Medistim ASA
Tel: + 47 918 38 110  
Email: kari.krogstad@medistim.com 

CFO, Thomas Jakobsen, Medistim ASA
Tel: + 47 906 59 940  
Email: thomas.jakobsen@medistim.com