Optimizing Reperfusion Trials: A Consensus Research Roadmap From the STAIR XIII Conference
The STAIR (Stroke Treatment Academic Industry Roundtable) sponsored a workshop during the STAIR XIII conference in Washington, DC on March 27 to 28, 2025, to develop consensus recommendations, particularly regarding research priorities and design elements for trials of reperfusion therapies. This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke, and industry representatives to discuss future developments in reperfusion therapies. The reperfusion trials session summarized and compared recent acute stroke trials. The workshop developed consensus recommendations for research priorities and trial design challenges. Given that the majority of patients eligible for reperfusion therapies present initially to primary stroke centers, developing research networks that allow trials to be conducted in the transfer setting and overcome the logistical challenges in such centers was identified as a key priority. A particular focus was the definition and investigation of microvascular reperfusion and the no-reflow phenomenon. Potential trial paradigms to advance the field were discussed. Recent acute stroke clinical trials have extended the scope of intravenous thrombolytics and endovascular thrombectomy. Recruitment for future trials at both primary and comprehensive stroke centers, in addition to standard of care, poses challenges, particularly for novel thrombolytics. Recommendations for enhancing stroke imaging research and the definition of macrovascular versus microvascular reperfusion are provided.
Authors
- Óscar Bolaños
- Jeremy Josef Heit (ORCID: https://orcid.org/0000-0003-1055-8000)
- Urs Fischer (ORCID: https://orcid.org/0000-0003-0521-4051)
- Johannes Boltze (ORCID: https://orcid.org/0000-0003-3956-4164)
- Opeolu M Adeoye (ORCID: https://orcid.org/0000-0001-8666-5369)
- H. Alex Choi (ORCID: https://orcid.org/0000-0001-7218-832X)
- Jean‐Claude Baron (ORCID: https://orcid.org/0000-0002-5264-2588)
- Carolina M. Maier
- Santiago Ortega‐Gutiérrez (ORCID: https://orcid.org/0000-0002-3408-1297)
- Michael Tymianski (ORCID: https://orcid.org/0000-0002-6311-9565)
- David S. Liebeskind (ORCID: https://orcid.org/0000-0002-5109-8736)
- Johanna Maria Ospel (ORCID: https://orcid.org/0000-0003-0029-6764)
- Gregory W. Albers (ORCID: https://orcid.org/0000-0003-0263-4632)
- Yunyun Xiong (ORCID: https://orcid.org/0000-0003-1353-2295)
- Gregory C. Makris (ORCID: https://orcid.org/0000-0003-3437-621X)
- Adrian Goh
- Sean I. Savitz (ORCID: https://orcid.org/0000-0003-4637-1790)
- Yasmin Tarek Ali Abdel Aziz (ORCID: https://orcid.org/0000-0002-3515-4005)
- Marcelo Borges Rocha (ORCID: https://orcid.org/0000-0003-4472-7423)
- George Harston (ORCID: https://orcid.org/0000-0003-4916-5757)
- Edgar Andres Samaniego (ORCID: https://orcid.org/0000-0003-2764-2268)
- Davide Carone (ORCID: https://orcid.org/0000-0002-1646-6089)
- Andrei V. Alexandrov (ORCID: https://orcid.org/0000-0001-8871-1023)
- Thanh N. Nguyen (ORCID: https://orcid.org/0000-0002-2810-1685)
- Felix Ng (ORCID: https://orcid.org/0000-0001-6973-8677)
- Emir Deljkich (ORCID: https://orcid.org/0009-0009-4785-5683)
- Jennifer Frontera (ORCID: https://orcid.org/0000-0002-0719-2522)
- Adrien ter Schiphorst (ORCID: https://orcid.org/0000-0002-7354-3351)
- Bruce C.V. Campbell (ORCID: https://orcid.org/0000-0003-3632-9433)
- Raul G. Nogueira (ORCID: https://orcid.org/0000-0003-4532-153X)
- Pooja Kumari Khatri (ORCID: https://orcid.org/0000-0002-7344-8266)
- Paul Wechsler (ORCID: https://orcid.org/0000-0002-0314-1867)
- Christopher G. Favilla (ORCID: https://orcid.org/0000-0003-0871-9549)
- Joseph P. Broderick (ORCID: https://orcid.org/0000-0002-7323-7709)
- Patrick D. Lyden (ORCID: https://orcid.org/0000-0001-6170-4042)
- Lee H. Schwamm (ORCID: https://orcid.org/0000-0003-0592-9145)
- Liping Liu (ORCID: https://orcid.org/0000-0003-2943-055X)
- Shunwei Zhu
- Michael D. Hill (ORCID: https://orcid.org/0000-0002-6269-1543)
- John A. Lynch (ORCID: https://orcid.org/0000-0003-3624-2741)
- R. D. Stewart
- Marc Fisher
- Kevin N. Sheth
Institutions
- National Health Service (GB)
- Boston Medical Center (US)
- The Royal Melbourne Hospital (AU)
- Inserm (FR)
- University of Calgary (CA)
- Université de Montpellier (FR)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Washington University in St. Louis (US)
- Université Paris Cité (FR)
- Florey Institute of Neuroscience and Mental Health (AU)
- University Hospital of Bern (CH)
- University of Iowa Hospitals and Clinics (US)
- Yale University (US)
- Beijing Tian Tan Hospital (CN)
- Centre Hospitalier Universitaire de Montpellier (FR)
- Banner - University Medical Center Phoenix (US)
- Thomas Foundation (AU)
- Meta (United States) (US)
- Groupe Hospitalier Cochin - Port-Royal, Hôtel-Dieu, Broca - La Collégiale (FR)
- Institut de Psychiatrie et Neurosciences de Paris (FR)
- Stanford Medicine (US)
- Thrombosis Research Institute (GB)
- FHU Neurovasc (FR)
- Oxford University Hospitals NHS Trust (GB)
- Austin Health (AU)
- University of Cincinnati (US)
- Bayer (Germany) (DE)
- University of Cincinnati Medical Center (US)
- Stanford University (US)
Publication Details
- Journal
- Stroke
- Published
- 2025-11-14
- DOI
- https://doi.org/10.1161/strokeaha.125.052148
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00