Footnotes

• Contributors All authors contributed to the conception, drafting, revisions and approval of this commentary. DFK is the guarantor of this work.

• Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests DFK: Consulting for Medtronic (all funds to the institution), ownership stake in Marblehead Medical, Superior Medical Experts; Research support from Medtronic, NeuroSigma, Shape Memory Therapeutics, IndumedX, Sequent Medical, NeuroSave, MicroVention; Advisory Board Triticum, Boston Scientific . JAH: Consulting for Medtronic (unrelated to this comment); Grant from Nieman Health Policy Institute (unrelated to this comment). AHS: Financial: Amnis Therapeutics, Apama Medical, BlinkTBI, Buffalo Technology Partners, Cardinal Health, Cerebrotech Medical Systems, Claret Medical, Cognition Medical, Endostream Medical, Imperative Care, International Medical Distribution Partners, Rebound Therapeutics Corp, Silk Road Medical, StimMed, Synchron, Three Rivers Medical, Viseon Spine; Consultant/Advisory Board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA, Cerebrotech Medical Systems, Cerenovus, Claret Medical, Corindus, Endostream Medical, Guidepoint Global Consulting, Imperative Care, Integra, Medtronic, MicroVention, Northwest University – DSMB Chair for HEAT Trial, Penumbra, Rapid Medical, Rebound Therapeutics Corp, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, VasSol, W L Gore & Associates; National PI/Steering Committees: Cerenovus LARGE Trial and ARISE II Trial, Medtronic SWIFT PRIME and SWIFT DIRECT Trials, MicroVention FRED Trial and CONFIDENCE Study, MUSC POSITIVE Trial, Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial.

• Patient consent Not required.

• Provenance and peer review Commissioned; internally peer reviewed.