Project Summary Stroke is the second leading cause of death worldwide with an even greater burden of major disability. It occurs at all ages with the greatest incidence in the elderly. The number of strokes is expected to rise in the US and worldwide as the population ages. In 2013, NINDS established NIH StrokeNet to harness the leadership and experience of the stroke research field to efficiently create and complete high-quality, multi-site trials and related biomarker validation and ancillary studies spanning prevention, treatment, and recovery. Since inception, the National Clinical Coordinating Center (NCC) at the University of Cincinnati has provided overall leadership and has coordinated activities within NIH StrokeNet. Our central objective is to engage the broader stroke community to successfully and efficiently design trials that are scientifically important, innovative, and feasible; to start trials expeditiously after being funded by NINDS; to successfully recruit and retain representative participants of the US population, and to maintain a pipeline of new clinical trialists by guiding the training, education, and career development of StrokeNet’s fellows and clinical research professionals. In addition to providing overall leadership and coordination for 24-27 regional coordinating centers affiliated with 500+ potential study sites, the NCC includes the StrokeNet research pharmacy and imaging activities. Our NCC team consists of two MPIs with over 50 years of collective experience designing, implementing, and completing multi-site clinical trials; over 30 NCC staff with in-depth expertise in coordinating, contracting, regulatory, pharmacy and imaging activities; a high level of support from University of Cincinnati; over 20 NCC co-investigators across the US with established expertise in the broad range of cerebrovascular disease and trial methodologies; and numerous international collaborators.