Aneurysmal subarachnoid hemorrhage (aSAH) occurs less often than other stroke types but affects younger patients, imposing a disproportionately high burden of long-term disability. Although management advances have improved outcomes over time, relatively few aSAH treatments have been tested in randomized clinical trials (RCTs). One lesson learned from COVID-19 is that trial platforms can facilitate the efficient execution of multicenter RCTs even in complex diseases during challenging conditions. An aSAH trial platform with standardized eligibility criteria, randomization procedures, and end point definitions would enable the study of multiple targeted interventions in a perpetual manner, with treatments entering and leaving the platform based on predefined decision algorithms. An umbrella institutional review board protocol and clinical trial agreement would allow individual arms to be efficiently added as amendments rather than stand-alone protocols. Standardized case report forms using the National Institutes of Health/National Institute of Neurological Disorders and Stroke common data elements and general protocol standardization across arms would create synergies for data management and monitoring. A Bayesian analysis framework would emphasize frequent interim looks to enable early termination of trial arms for futility, common controls, borrowing of information across arms, and adaptive designs. A protocol development committee would assist investigators and encourage pragmatic designs to maximize generalizability, reduce site burden, and execute trials efficiently and cost-effectively. Despite decades of steady clinical progress in the management of aSAH, poor patient outcomes remain common, and despite the increasing availability of RCT data in other fields, it remains difficult to perform RCTs to guide more effective care for aSAH. The development of a platform for pragmatic RCTs in aSAH would help close the evidence gap between aSAH and other stroke types and improve outcomes for this important disease with its disproportionate public health burden., Competing Interests: Dr Kamel reports an ownership stake in TET Medical, compensation from American Medical Association and Javelin Medical for consultant services, compensation from Boehringer Ingelheim for end point review committee services, employment by Weill Cornell Medical College, compensation from Medtronic and Janssen Biotech for other services, and compensation from Novo Nordisk and AstraZeneca for end point review committee services. Dr Suarez reports compensation from Acasti Pharma for data and safety monitoring services and compensation from Cyban for consultant services. Dr Mack reports compensation from Viseon, Inc, for consultant services, compensation from Spartan Micro for consultant services, compensation from Cerebrotech for other services, compensation from Integra LifeSciences for consultant services, stock options in Spartan Micro, compensation from Egret for consultant services, stock options in Stream Biomedical, compensation from Viseon for other services, compensation from Endostream for other services, compensation from Vastrax for other services, stock holdings in Rebound Therapeutics, employment by the University of Southern California, compensation from Q’Apel for consultant services, compensation from Imperative Care, Inc, for consultant services, compensation from Radical Catheters for other services, compensation from Q’Apel for other services, stock options in Egret, compensation from Medtronic for other services, compensation from Stream Biomedical for consultant services, stock holdings in Truvic, compensation from Borvo for other services, and compensation from Stryker for data and safety monitoring services. Dr Chou reports compensation from Acasti for consultant services; employment by Northwestern Medicine; compensation from CSL Behring for consultant services; service as a member of the Board of Directors for the Neurocritical Care Society; grants from the Neurocritical Care Society; compensation from BioVie for consultant services; grants from the National Institute of Neurological Disorders and Stroke; and employment by Northwestern University. Dr Busl reports grants from the National Institutes of Health (NIH). Dr Derdeyn reports compensation from noNO for data and safety monitoring services, compensation from Silk Road Medical, Inc, for data and safety monitoring services, stock options in Euphrates Vascular, and compensation from Penumbra, Inc, for data and safety monitoring services. Dr Dangayach reports employment by Icahn School of Medicine at Mount Sinai, grants from Visionable, compensation from The Jacob’s Institute for consultant services, grants from Ceibahealth, grants from The Aneurysm and AVM Foundation (TAAF), grants from Neurosteer, and grants from American Academy of Neurology. Dr Elm reports compensation from CSL Behring for consultant services and grants from NIH. Dr Beall reports grants from NIH. Dr Ko reports compensation from Route 92 Medical, Inc, for data and safety monitoring services; service on the Board of Directors for TAAF; employment by the School of Medicine, University of California, San Francisco; and funding from the American Heart Association and NIH. The other authors report no conflicts.