Abstract:

After reperfusion therapy for acute ischemic stroke (AIS), the hemorrhagic transformation caused by reperfusion is uncommon, but it seriously affects the prognosis and neurological recovery of the patients. At present, the mechanisms of bleeding transformation that have been extensively studied include ischemia injury, ischemia reperfusion, coagulation dysfunction caused by Alteplase (rt-PA), and destruction of blood-brain barrier. The early detection and prevention of hemorrhagic transformation (HT) can be achieved through recognizing clinical risk factors and applying predictive models and multimodal imaging. Future use of novel thrombolytic drugs and newly developed brain protectants is expected to control HT conversion further and improve patients' outcomes. This review summarizes the classification, pathophysiological mechanisms, risk factors, predictors and predictive models, and corresponding treatment of HT, for timely recognizing and prevention, and at the same time, individualized treatment should be given to reduce the harm of serious complications as far as possible, and improve the benefit rate of vascular recanalization in AIS patients after reperfusion therapy and reduce the neurological function damage to promote the prognosis.

Key words: Acute ischemic stroke, Reperfusion therapy, Hemorrhagic transformation, Mechanism