Project Summary/Abstract The University of Iowa Regional Coordinating Stroke Center (UIRCC) is ideally positioned to develop, promote, and efficiently conduct high-quality, multi-site clinical trials on stroke prevention, treatment, and recovery, in line with the overarching goal of the NIH StrokeNet. The University of Iowa (UI) is the only academic medical institution and comprehensive stroke center in the state. The UI has led and participated in landmark clinical trials in cerebrovascular disease for over 50 years such as the Org 10172 in Acute Stroke Treatment (TOAST) study, the NIH Stroke Scale, and the TOAST classification of stroke subtype. Over the past 10 years, the UI has served as the UIRCC, bringing together our tradition of multidisciplinary, cutting-edge, cerebrovascular research. We demonstrated our ability to recruit patients by becoming the top enroller in the first StrokeNet trial, DEFUSE-3, and attracting a diverse patient population from the Upper Midwest—a region that experiences unique geographic barriers for enrollment. The UIRCC is committed to mitigating this unacceptable disparity. We are committed to holistically expanding stroke care by increasing the number of stroke interventions that effectively improve patient outcomes, and by expanding the number of patients who can benefit from such interventions. We have a strong commitment to remain a productive member of StrokeNet. Our first aim is to further advance the UIRCC as an efficient and adaptive infrastructure to recruit patients from the Upper Midwest. The restructured UIRCC comprises eight trial-ready geographically linked hospitals that will efficiently conduct critical trials and provide access to patients living in 119 counties from seven states, 56% of whom reside in rural zip codes and traditionally have been excluded from trials due to geographic barriers. It also includes a significant underserved Native American population. Our second aim is to continue to develop innovative interventions to expand stroke care. We plan to reproduce our uric acid success story, the first cryoprotectant to succeed through the NIH Stroke Preclinical Assessment Network (SPAN). Our group will now be leading the testing of uric acid through the new StrokeNet Thrombectomy Endovascular Platform (STEP). We will continue to build on our multidisciplinary research infrastructure, a diverse group of investigators and trainees. This includes the UI SPAN translational team, as well as clinical researchers and industry partners. This infrastructure will continue to leverage dedicated UI pilot funds to ignite the development of interventions, with an emphasis on those that are simple and therefore widely applicable to a geographically diverse groups of patients.