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

TIME-ICH (TrIal of early Minimally Invasive catheter Evacuation with thrombolysis in IntraCerebral Hemorrhage) is a multicenter, randomized, adaptive clinical trial comparing best medical management to early minimally invasive surgery with thrombolysis (eMIST) in the treatment of acute spontaneous supratentorial 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 be initiated 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, or cerebellar; 2. Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly, Moyamoya disease, venous sinus thrombosis, mass or tumor, hemorrhagic conversion of an ischemic infarct, tumor stroke, recurrence of a recent (\ 220 mmHg; 5. Irreversible impaired brain stem function (bilateral fixed, dilated pupils and extensor motor posturing), GCS ≤ 4; 6. Hemorrhage with apparent midbrain extension with third nerve palsy or dilated and non-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 days from 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 history of surgical sterilization or is post-menopausal; 14. Urokinase allergy; 15. Any concurrent serious illness that would interfere with the outcome assessments including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic, and hematologic disease; 16. Inability or unwillingness of patient or legal representative to give written informed consent; 17. Known life-expectancy of less than 6 months; 18. Participation in a concurrent interventional medical investigation or clinical trial.