MIND: Artemis in the Removal of Intracerebral Hemorrhage

Inclusion Criteria:

1. Patient age ≥ 18 and ≤ 80
2. Supratentorial ICH of volume ≥ 20 and ≤ 80 cc (measured using A x B X C/2 method)
3. Hemostasis as confirmed by no arterial spot sign (may perform additional scan(s) every 6 hours to demonstrate hemostasis)
4. NIHSS ≥ 6
5. GCS ≥ 5 and ≤ 15
6. Historical mRS 0 or 1
7. Symptom onset < 24 hours prior to initial CT/MR
8. MIS must be initiated within 72 hours of ictus/bleed
9. SBP must be < 180 mmHg and controlled at this level for at least 6 hours

Exclusion Criteria:

1. Imaging
2. "Arterial Spot Sign" identified on final CTA indicating expanding hemorrhage
3. Hemorrhagic lesion such as a vascular malformation (cavernous malformation, AVMetc.), aneurysm, and/or neoplasm
4. Hemorrhagic conversion of an underlying ischemic stroke
5. Infratentorial hemorrhage
6. Primary thalamic ICH (where the center of the hemorrhage emulates from thethalamus)
7. Associated intra-ventricular hemorrhage requiring treatment for IVH-related masseffect or shift due to trapped ventricle (EVD for ICP management is allowed)
8. Midbrain extension/involvement
9. Absolute contraindication to CTA, conventional angiography and MRA
10. Coagulation Issues
11. Absolute requirement for long-term anti-coagulation (e.g., mechanical valvereplacement (bio-prostatic valve is permitted), high risk atrial fibrillation)
12. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency
13. Platelet count < 100 x 10^3 cells/mm3 or known platelet dysfunction
14. INR > 1.4, elevated prothrombin time or activated partial thromboplastin time (aPTT), which cannot be corrected or otherwise accounted for (i.e., lupusanti-coagulant)
15. Use of direct factor Xa inhibitors (e.g. apixaban, rivaroxaban, fondaparinux)within last 48 hours
16. Patient Factors
17. Traumatic ICH
18. High risk atrial fibrillation (e.g., mitral stenosis with atrial fibrillation)and/or symptomatic carotid stenosis
19. Requirement for emergent surgical decompression or uncontrolled ICP after EVD
20. Unable to obtain consent per Institution Review Board/Ethics Committee policy
21. Pregnancy or positive pregnancy test (either serum or urine). Women ofchild-bearing potential must have a negative pregnancy test prior to enrollment
22. Severe active infection requiring treatment (e.g. sepsis or purulent wound) atthe time of enrollment
23. Renal failure indicated by creatinine > 2 mg/dL or undergoing dialysis
24. Any comorbid disease or condition expected to compromise survival or ability tocomplete follow-up assessments through 365 days
25. Based on investigator's judgement, patient is unwilling or unable to comply withprotocol follow up appointment schedule
26. Active drug or alcohol use or dependence that, in the opinion of the siteinvestigator would interfere with adherence to study requirements
27. Currently participating in another interventional (drug, device, etc) clinicaltrial. Patients in observational, natural history, and/or epidemiological studiesnot involving intervention are eligible.