• Research Priorities – Cerebral Reperfusion
  • Identify and test nonneurotoxic thrombolytics, understand mechanisms by which current thrombolytics damage vessels and neurons.
  • Determine the most optimal approaches of ultrasound facilitation of clot lysis. Evaluate methods for delivering thrombolytic agents using microbubble targeting.
    Obtain knowledge on the bioeffects of therapeutic ultrasound applications for treatment of stroke to optimize therapeutic goals and limit adverse side effects.
  • Organize clinical trials of intra-arterial approaches integrated with intravenous thrombolysis.
  • Develop methods to identify individual variability inresponse to thromboembolic occlusion in cerebral arteries.
• Research Priorities – Optimizing the Delivery of Stroke Care
  • Produce new data on optimal care of acute stroke patients and identify factors that may delay and factors that may facilitate broad implementation of evidencebased stroke interventions.
  • Identify methods for optimal hyperacute, prehospital management of stroke and subject them to clinical evaluation.
  • Link new mobile brain imaging equipment for prehospital diagnosis of stroke with advanced telemedicine to provide new strategies for prehospital therapy of stroke.
• Research Priorities – Brain Protection
  • Identify strategies to protect not only neurons, but also vascular and glial cells after focal cerebral ischemia.
    Focus more on white matter injury, small vessel disease and address vascular dementia.
  • Conduct multinational preclinical trials on combination therapy. Establish SOPs, ‘good laboratory practice’, and reporting standards for experimental stroke research.
  • Identify and understand cardiovascular-brain and neuralimmune interactions after stroke, develop therapeutic stra tegies.
  • Evaluate neuroprotective and neurorecovery-enhancing treatments as stand-alone and combined therapies in clinical trials.
• Research Priorities – Recovery after Stroke
  • Test various types of stem cells in animal models of stroke for their ability to generate and replace neurons which have died, to remyelinate the demyelinated axons, and to repair damaged neural circuitries.
  • Explore contribution of endogenous neurogenesis to functional recovery after stroke. Learn how to trigger production of cortical neurons and stimulate integration into neural circuitries.
  • Combine stem cell and gene therapy for stroke recovery. Stem cells could be genetically modified to improve their survival and differentiation, or genes could be delivered directly into the stroke-damaged brain to improve the migration and functional integration of the grafted cells.
  • Further develop imaging techniques for assessment of grafted and endogenous stem cell survival, migration, and function after stroke.
• Research Priorities – Cerebrovascular Biology
  • Perform research on the molecular and cellular biology of the BBB to understand the regulation of BBB characteristics in CNS endothelium as a prerequisite to understand the pathophysiology of the CNS microcirculation during stroke.
  • Understand the cellular and molecular mechanisms with which endothelial cells of the BBB react to focal cerebral ischemia, identify targets to protect these cells, the BBB, and the neurovascular unit against damage. Define markers of BBB disruption, and markers that can predict hemorrhage induced by thrombolytics.
  • Understand the sequence of molecular traffic signals involved in leukocyte recruitment across the BBB in order to specifically prevent the migration of pathogenic leukocytes into the CNS, while at the same time maintaining the recruitment of potential repair cells.
  • Understand and target angiogenesis, vasculogenesis, arteriogenesis after (or before) a stroke. Study the interaction of angiogenesis and neurogenesis, in particular after stroke.
  • Develop small animal models for lacunar stroke. Investigate mechanisms of damage as they relate to nonlarge vessel occlusion.
• Research Priorities – Stroke Imaging
  • Understand what the underlying pathophysiology is that produces a ‘penumbra’ when PET, MR, ultrasound or CT measures it. Validate the underlying concept with invasive methods in experimental models.
  • European stroke researchers need to be integrated and team up with networks of scientists in which new imaging methodologies are being developed and validated, and contribute stroke specific aspects and models.
  • Develop new approaches for molecular imaging. Use imaging to better understand lesion maturation and progression and clinical deterioration, and to monitor the effect of treatments.
• Research Priorities – Stroke Prevention
• Novel risk factors for stroke should be identified. Moreover, we must learn how existing risk factors differ by subtype.
• Large networks should be developed to achieve the sample sizes necessary to study this highly heterogeneous clinical syndrome.
• Understand genetic susceptibility to stroke, as well as to the genetic influence on acute stroke pathology and recovery.