The Web streams spec requires promise creation at numerous points, often in hot paths and often invisible to users. Each read() call doesn't just return a promise; internally, the implementation creates additional promises for queue management, pull() coordination, and backpressure signaling.
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The trade-off is performance. Every syscall goes through user-space interception, which adds overhead. I/O-heavy workloads feel this the most. For short-lived code execution like scripts and tests, it is usually fine, but for sustained high-throughput I/O, it can matter.