Superior Sagittal Sinus, Portal and Caval Vein and Abdominal Aorta Pressure Recording Ligation of the superior sagittal sinus immediately overwhelms normal (negative) pressure, and induces the increased (positive) pressure, along with the severe portal and caval hypertension (portal hypertension exceeding caval hypertension), and aortal hypotension, persisting throughout the entire experimental period (Figure 5)
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Methods: Study design: Multicentre cluster RCT with included health economic and process evaluations Study setting: Ambulance services, local stroke units and CSCs in England Cluster randomisation: Ambulance stations or teams Intervention: Specialist pre-hospital redirection pathway involving semi-structured telephone communication of information from ambulance to CSC clinicians, who then recommend admission destination according to the likelihood of treatable LVO being present Control: Standard care Study population: All suspected and confirmed stroke in participating regions Participant enrolment: Waiver of consent Co-primary outcome: Thrombectomy rate and time to treatment Secondary outcomes: Key aspects of emergency care including time intervals and receipt of other treatments including thrombolysis Sample size: Powered on a primary analysis population(ischaemic stroke), 564 thrombectomy procedures will detect at least 30-minutes difference in time to treatment

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