In contrast with the recent editions of Point–Counterpoint which have explored popular and timely concerns such as training requirements, the status of endovascular treatment strategies for stroke and intracranial atherosclerosis as well as the role of perfusion imaging in the evaluation of acute ischemic stroke, this edition focuses on perhaps one of the less engaging but equally critical matter of prophylactic antiplatelet therapy in neurointerventional surgery. The phrase ‘persistent platelet reactivity’ likely induces angst in most neurointerventionalists who want to do the right thing for patients but who cannot keep up with the relevant information on the reliability or efficacy of platelet …