The hyperdense vessel sign on CT and susceptibility vessel sign (SVS) on MRI have been associated with red blood cell-rich clots and have been reported to be associated with better reperfusion rates and better response to stent-retrievers as the first-line modality.3 In the Adaptive Endovascular Strategy to the Clot MRI in Large Intracranial Vessel Occlusion (VECTOR) study, Romain Bourcier and colleagues aimed to compare the safety and efficacy of a stent retriever plus contact aspiration (combined technique) versus contact aspiration alone in patients with SVS-positive occlusions.4 VECTOR was a randomised, open-label study with blinded-endpoint evaluation. 521 patients (≥18 years of age) with SVS-positive occlusion of the internal carotid artery or middle cerebral artery (M1 or proximal M2 segment) on pretreatment MRI and arterial puncture within 24 h of symptom onset were randomly assigned 1:1 to first-line endovascular therapy with either the combined technique (n=263) or contact aspiration alone (n=258), in France. The randomised study design and blinded endpoint evaluation, along with the low crossover rates, ensure rigorous results. TNN has participated in advisory boards for Aruna Bio and Brainomix (one time); is co-Principal Investigator of the SUMMIT MAX and PICASSO trials; has participated in data safety monitoring boards for the CREST2, SELECT2, TESLA, TATUM, WE-TRUST, and HEMERA trials (all unpaid except CREST2; payment from the National Institutes of Health); is a member of the clinical events committee for ENDOLOW (payment from Emory University); is an Associate Editor of Stroke; and is President of the Society of Vascular and Interventional Neurology.