Rapid Evacuation and Access of Cerebral Hemorrhage Trial

Inclusion Criteria:

• Age 18-70 years

• Pre-randomization head CT demonstrating an acute, spontaneous, anterior basalganglia primary intracerebral hemorrhage (ICH) (the anterior basal ganglia includethe caudate, putamen, and pallidum to the capsula externa and excludes the thalamus)

• ICH volume between 20 - 80 mL as calculated by an approved and standardizedvolumetric measurement

• Study intervention can reasonably be initiated within 24 hours after the onset ofstroke symptoms. If the onset is unclear, then the onset will be considered the timethat the subject was last known to be well.

• Glasgow Coma Score (GCS) 5 - 14

• Historical Modified Rankin Score 0 or 1

Exclusion Criteria:

• Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly, Moyamoyadisease, venous sinus thrombosis, mass or tumor, hemorrhagic conversion of anischemic infarct, recurrence of a recent (less than 1 year) ICH, as diagnosed withradiographic imaging

• NIH Stroke Scale (NIHSS) less than or equal to 5

• Bilateral fixed dilated pupils

• Extensor motor posturing

• Intraventricular extension of the hemorrhage is visually estimated to involvegreater than 50% of either of the lateral ventricles

• Primary thalamic ICH or basal ganglia hemorrhage with involvement > 25% of thalamus

• Infratentorial intraparenchymal hemorrhage including midbrain, pontine, orcerebellar

• Use of anticoagulants that cannot be rapidly reversed (i.e., criteria is met ifinvestigators are confident that clinically significant coagulopathy is not presentafter targeted correction)

• Evidence of active bleeding involving a retroperitoneal, gastrointestinal,genitourinary, or respiratory tract site

• Uncorrected coagulopathy or known clotting disorder

• Known platelet count less than 75,000 or known international normalized ratio (INR)greater than 1.4 after correction

• Patients requiring long-term anti-coagulation that needs to be initiated less thanor equal to 5 days from initial ICH

• End-stage renal disease

• Patients with a mechanical heart valve

• End-stage liver disease

• History of drug or alcohol use or dependence that, in the opinion of the siteinvestigator, would interfere with adherence to study requirements

• Positive urine or serum pregnancy test in female subjects without documented historyof surgical sterilization or post-menopausal

• Known life expectancy of less than 6 months before ICH

• No reasonable expectation of recovery, do-not-resuscitate (DNR), or comfort measuresonly before randomization

• Participation in a concurrent interventional medical investigation or clinicaltrial. Patients in non-interventional/observational studies are eligible

• Inability or unwillingness of the subject or legal guardian/representative to givewritten informed consent

• Homelessness or inability to meet follow-up requirements