Project Summary The burden of stroke disproportionately impacts the Southeast United States- a region known as the “Stroke Belt”. Outreach to populations in this region for stroke education, prevention, acute treatment, rehabilitation, and participation in clinical research, remains a challenge. In order to change the disproportionate stroke burden of this region, a highly functional clinical and research multicenter infrastructure to engage populations at high risk for stroke is critical. In this application, investigators in the Southeast Collaborative Alliance for Stroke Trials (SE-CoAST) are committed to continuing to serve as a Regional Coordinating Center (RCC) in Stroke Net. SE-CoAST is now an expanded, robust collaboration between 5 tertiary care medical centers situated in the heart of the Stroke Belt: the Medical University of South Carolina along the South Carolina (SC) coast, the University of South Carolina at Columbia (Prisma Health Richland) in the Midlands of SC, the University of South Carolina at Greenville (Prisma Health Upstate) in the Upstate of SC, the Augusta University Medical Center in eastern Georgia, and Guilford Neurological Associates (Moses Cone Health) in western North Carolina. The greatest strength of this expanded network is our established partnerships in research and stroke care delivery, which has resulted in SE-CoAST emerging as one of the top recruiting Stroke Net RCCs overall. SE-CoAST has also been the #1 recruiting RCC in the Stroke Belt and the #1 recruiting RCC of Black subjects. SE-CoAST Investigators continue to make significant contributions to national Stroke Net activities, serving on Stroke Net national committees and in leadership roles for Stroke Net clinical trials. Additionally, the SE-CoAST training core has a proven track record of successful faculty development of a diverse group of Stroke Net Scholars. Over the next 5 years, the goals of SE-CoAST are: 1) to leverage the SE-CoAST organization to accelerate trial start-up and increase recruitment and retention in Stroke Net trials while continuing to ensure high-quality data collection; 2) to make impactful contributions to the leadership of Stroke Net activities nationally; 3) Provide a fertile learning environment that includes strong mentorship and support to enhance the career development of our Stroke Net scholars. Our commitment to enrolling a diverse population of subjects from a highly stroke-prone region and the experience and leadership of our expanded multicenter team makes SE- CoAST a highly successful and valuable member of Stroke Net.