Stroke is a major and debilitating complication following aortic arch surgery. Professor Tristan Yan has organised an international coalition of centres (International Aortic Arch Surgery Study Group (IAASSG) to provide more robust investigations into this topic. The IAASSG has been formed by 41 arch surgeons from 10 countries to better evaluate patient outcomes after aortic arch surgery. So far the Arch Projects database contains clinical information of 12,500 aortic arch patients, which is the largest registry on this topic to date. Several other projects, including the establishment of randomized controlled trials and a prospectively collected database, are currently underway. Such a collaborative effort will herald a turning point in the surgical management of aortic arch pathologies and will provide better powered analyses to assess the impact of varying surgical techniques on mortality and morbidity, identify predictors for neurological and operative risk, formulate and validate risk predictor models and review long-term survival outcomes and quality-of-life after arch surgery.