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.