Competing interests: MRL: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery, Data safety monitoring board of Arsenal Medical; site PI, EMBOLISE clinical trial. JAH: Consulting agreement with Medtronic, Sanofi, Relievant, and Cerenovus; data safety monitoring board for Balt, Rapid Medical, Arsenal Medical; grant Support from the Neiman Health Policy Institute; editorial board of Journal of NeuroInterventional Surgery. MC: Consulting agreement with Medtronic, Penumbra, Q’Apel, RapidPulse, Balt, DSM Biomedical, Guerbet; editorial board of Journal of Neurointerventional Surgery; Clinical Events Committee for the STEM trial.