Despite dropping to the fourth leading cause of death in the United States, the incidence of stroke continues to rise and the individual and societal impact continues to grow. The burden of stroke disproportionately impacts lower socioeconomic populations and is particularly concentrated in the Southeast United States - the so-called Stroke Belt. Reaching these populations for stroke education, prevention, acute treatment, rehabilitation, and in particular in engagement in clinical research, remains a challenge. Developing clinical and research infrastructures to engage these populations are critical to change the disproportionate stroke burden. The perception of stroke as a treatable disease and the systems of care developed to manage stroke have made major advances from a time when stroke was viewed nihilistically. The development of fibrinolysis for stroke dramatically changed the paradigm for acute stroke treatment - for the first time acute ischemic stroke could be "reversed". This development provided promise and enthusiasm for developing further preventative, acute interventions, and novel rehabilitation strategies, but to date, clinical trial of potential therapies have yet to produce a definitive new reperfusion strategy. Conducting multicenter clinical trials of stroke therapies and interventions often must be performed within a highly contracted time scale, requiring innovative thinking and redesign of many aspects of the science of clinical trials. To be effective and fast, the NINDS Stroke Trials Network will require spectrum of clinicians, researchers, and allied healthcare providers to create a regional infrastructure that will effectively and efficiently recruit patients into trials across the broad spectrum of stroke etiologies and time frames. In this application the investigators propose to become a Regional Coordinating Center (RCC) in the NINDS Stroke Trials Network (RFA-NS-13-011). The South Carolina Collaborative Alliance for Stroke Irials (SC-CoAST) Network is a unique collaboration between 3 academic medical centers, the Medical University of South Carolina, the University of South Carolina, and the Greenville Heath System, situated in the heart of the Stroke Belt. The overall goals of the SC-CoAST Network are: 1) to expand the SC state-wide stroke organization to improve stroke care and research;2) to leverage the SC-CoAST collaboration to become a leading center within the STN;3) to utilize SC-CoAST preclinical researchers in developing potential interventions for study within the STN;and 4) to engage SC-CoAST senior leaders in identifying, mentoring, and training young clinician-scientists at this formative stage of their career development.
The SC-CoAST RCC will provide a large integrated clinical trials network throughout most of South Carolina that will engage and enlist urban and rural/underserved communities and hospitals into the clinical research enterprise and disseminate best clinical and research practices throughout the state where stroke remains a major health hazard. The SC-CoAST RCC represents an effective and efficient mechanism to perform critical clinical research in accordance with the mission ofthe NINDS Stroke Trials Network.