Cleveland is an urban community with several healthcare systems, internationally renowned researchers and a rich history of cooperation with respect to stroke care. University Hospitals of Cleveland (University Hospitals), The Cleveland Clinic, MetroHealth and the Louis Stokes Cleveland VA Medical Center (Cleveland VA) are affliated with Case Western Reserve University (CWRU) and collaborate in a Clinical Translational Science Collaborative (CTSC- funded by a CTSA) to enhance training, research, and discovery in Cleveland. In 2013 we were awarded a Regional Coordinating Center (RCC) as part of NIH StrokeNet. This application is to to renew that grant. We have expanded our RCC adding sites in Toledo (Mercy St Vincent Medical Center or Mercy St Vincent), Columbus (OhioHealth), Grand Rapids, Michigan (SpectrumHealth) and Morgantown, WV (West Virginial University (WVU). The inclusion of one county hospital with a large emergency department, VA hospital, and two urban academic medical centers, one academic medical center in a rural state ensures a diverse patient and study population. Our RCC has excellent participation and quality metrics on StrokeNet studies, including the highest enrollment in StrokeNet study in the Great Lakes Region. We have a diverse research community, with clinical researchers, basic scientists, engineers and biotech companies, to collaborate with and bring new projects to the network. We have large hospitals systems, including 3 hospitals ranked in the top 50 Neurology and Neurosurgery programs in the country, 6 Comprehensive Stroke Centers and a seventh site that will be reviewed for Comprehensive designation in October 2017. We have state of the art transportation resources including critical care air transport with physicians and nurse practicioners on board and 2 hospital systems with mobile stroke units that administer thrombolytics in the field or en route to the hospital. We have special expertise in penumbral imaging, acute endovascular therapy and rehabilitation and functional electrical stimulation. We propose a multi-teired leadership. Dr Sophia Sundararajan and Dr. Ken Uchino will lead the RCC as PIs, and representatives from each of the eight hospitals will serve on the Executive committee with the PIs, as will a Project Manager and Training Director. The Executive Committee includes senior and more junior investigators and will oversee and run all aspects of the RCC, but also provide mentorship for more junior investigators. Our leadership succession plan has already successfully mentored Drs Sundararajan and Uchino who will assume the Co-PI roles of this application. With the expertise and resources detailed in this application, the Case Western Reserve University RCC will be well positioned to enhance the structure and organization of our RCC and further accelerate participation in clinical trials for stroke acute intervention, prevention and rehabilitation in both adults and children.