TrIal of Early Minimally Invasive Catheter Evacuation With Thrombolysis in IntraCerebral Hemorrhage

Inclusion Criteria:

1. Age ≥ 18 years;

2. Pre-randomization head CT demonstrating an acute, spontaneous, primary ICH;

3. ICH volume ≥ 20mL as calculated by the ABC/2 method;

4. The randomization can be completed within 8 hours after the onset of stroke symptoms (or the time last known to be well), and study intervention can reasonably beinitiated within 4 hours after randomization.

5. Historical Modified Rankin Score 0 or 1;

6. Obtain informed consent from patient or legal representative.

Exclusion Criteria:

1. Infratentorial intraparenchymal hemorrhage including midbrain, pontine, orcerebellar;

2. Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly, Moyamoyadisease, venous sinus thrombosis, mass or tumor, hemorrhagic conversion of anischemic infarct, tumor stroke, recurrence of a recent (<1 year) ICH, as diagnosedwith radiographic imaging;

3. Presence of spot sign in CT angiography;

4. Blood pressure control before randomization is ineffective, systolic blood pressure > 220 mmHg;

5. Irreversible impaired brain stem function (bilateral fixed, dilated pupils andextensor motor posturing), GCS ≤ 4;

6. Hemorrhage with apparent midbrain extension with third nerve palsy or dilated andnon-reactive pupils. Other (supranuclear) gaze abnormalities are not exclusions;

7. Intraventricular extension of the Hemorrhage is visually estimated to involve >50%of either of the lateral ventricles;

8. Any irreversible coagulopathy or known clotting disorder.

9. Platelet count < 750,000, INR > 1.4 after correction

10. Patients requiring long-term anti-coagulation that needs to be initiated < 30 daysfrom index ICH;

11. Use of 2 or more antithrombotic drugs prior to symptom onset;

12. Patients with a mechanical heart valve;

13. Positive urine or serum pregnancy test in female subjects without documented historyof surgical sterilization or is post-menopausal;

14. Urokinase allergy;

15. Any concurrent serious illness that would interfere with the outcome assessmentsincluding hepatic, renal, gastroenterologic, respiratory, cardiovascular,endocrinologic, immunologic, and hematologic disease;

16. Inability or unwillingness of patient or legal representative to give writteninformed consent;

17. Known life-expectancy of less than 6 months;

18. Participation in a concurrent interventional medical investigation or clinicaltrial.