Background: Hemorrhagic transformation (HT) is a common and natural complication after
acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid
reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate
the risk and severity of HT and to be associated with increased morbidity and mortality.
Objective: The aim of this review is to discuss the multifactorial pathophysiology of hemorrhagic
transformation, promising interventional targets, and pharmacological treatment options.
Results and Conclusion: Understanding HT is essential to restore cerebral blood flow to ischemic
brain by reperfusion therapy without causing this complication and additional brain injury. Therefore
methods for the prevention and treatment of HT are needed. Although experimental studies showed
promising results, clinical translation remains unsatisfactory to date.