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Methods to conduct minimally invasive hematoma evacuation for intracerebral hemorrhage are available, but high-quality evidence establishing efficacy is lacking. In the current study, investigators screened 19,942 patients with spontaneous supratentorial intracerebral hemorrhage to identify those with hematoma volumes of ≥30 mL that were stable in size for ≥6 hours, to enroll 506 patients between 12 and 72 hours after symptom onset. In patients randomized to the intervention, a surgeon placed a burr hole and inserted a catheter along the hematoma's long axis, then used this catheter to aspirate clot and administer up to 9 doses of alteplase directly into the hematoma every 8 hours, aiming to reduce hematoma volume to <15 mL. The study was p…