The ALIAS (Albumin in Acute Ischemic Stroke) part II trial of high-dose albumin infusion versus placebo in patients with AIS was terminated early for futility.232 Combined analysis of the ALIAS parts I and II trials demonstrated no difference between groups in 90-day disability.233 See Table LII in online Data Supplement 1. Powers et al 2019 Guidelines for Management of AIS e379 The administration of vasodilatory agents, such as pentoxifylline, is not recommended for treatment of patients with AIS. III: No Benefit A Recommendation and LOE unchanged from 2013 AIS Guidelines. COR amended to conform with ACC/AHA 2015 Recommendation Classification System. Devices to mechanically augment cerebral blood flow for the treatment of patients with AIS are not useful. III: No Benefit B-R New recommendation. Since the 2013 AHA/ASA Guideline, a safety and feasibility RCT of external counterpulsation in AIS has been External counterpulsation was safe and feasible to use in patients with AIS but was associated with unexpected effects on MCA flow velocity. At 30 days, there were no statistically significant differences in clinical end points between the 2 groups, but the study was not powered for this purpose. See Table LIII in online Data Supplement 1. 3.12. Neuroprotective Agents 3.12. Neuroprotective Agents COR LOE New, Revised, or Unchanged At present, pharmacological or nonpharmacological treatments with putative neuroprotective actions are not recommended. III: No Benefit A Recommendation reworded for clarity from 2013 AIS Guidelines. LOE unchanged. COR amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. There have been myriad attempts to establish the efficacy of pharmacological and nonpharmacological interventions with putative neuroprotective action in acute stroke that have failed when tested in human clinical trials. 