The success of the 2015 stroke trials changed the indications for mechanical thrombectomy and the landscape of acute stroke care.1–5 A treatment we have always believed to be beneficial was shown, without doubt, to be effective. Systems of care have been designed around IA therapy for acute stroke. Procedural volumes have increased dramatically. Most importantly, a large number of patients have directly benefitted from this procedure. The 2015 mechanical thrombectomy studies succeeded for many reasons. The trials were thoughtful and well designed. The operators were experienced. Recanalization rates have now improved drastically. Thrombolysis in Cerebral Infarction 2b or 3 is now the expectation, and short procedural times the norm. Regardless of specific recanalization methods, we, as a field, have become very good at opening occluded blood vessels quickly. There remains room for improvement, but the margin is decreasing. Device development and procedural adaptations have been the bell cow thus far; tools have evolved from the Merci device to aspiration and stentrievers. Balloon guide catheters and direct carotid access have played a role. We have all recognized that we need to …