Roger Greenhalgh (London, UK) is joined by Fiona Rohlffs (Hamburg, Germany), Tilo Kölbel (Hamburg, Germany) and Heinz Jakob (Essen, Germany) to discuss the latest findings of the Stroke from Thoracic Endovascular Procedures (STEP) study which were presented at CX 2019 (Charing Cross Symposium; 15–18 April 2019, London, UK).