JNIS Associate Editor Joshua Hirsch is joined by Shazam Hussain (Cerebrovascular Center, Cleveland Clinic, Ohio, USA) and David Fiorella (Department of Neurosurgery, Stony Brook University, New York, USA) to discuss the June 2017's editorial in the Journal of Neurointerventional Surgery.

In this commentary, they analyse the conclusions of the study “Public Health Urgency Created by the Success of Mechanical Thrombectomy Studies in Stroke”, published by Circulation, stating that the opinions of Drs Hopkins and Holmes “lead to unwarranted conclusions that have dangerous implications for patient care”.

The authors of the JNIS editorial comment on three major points of controversy:

(1) a disregard for training, expertise, and experience in the management of a disease that may lead to death or disability when treating physicians do not have them;

(2) a misunderstanding of the fundamental underpinnings of stroke physiology and anatomy;

(3) a false association between a real problem (undeveloped systems of care) and a spurious assumption (ie, that there are not enough physicians trained to perform intracranial MT). We examine these concerns below.

The editorial “In defense of our patients” was written on behalf of the Society of NeuroInterventional Surgery, the Cerebrovascular Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, and the Society of Vascular and Interventional Neurology.