Hong Ji Man, Kim Da Sol, Kim Min
Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon-si, South Korea.
Department of Biomedical Science, Ajou University School of Medicine, Ajou University Medical Center, Suwon-si, South Korea.
Front Neurol. 2021 Nov 30;12:703258. doi: 10.3389/fneur.2021.703258. eCollection 2021.
Symptomatic hemorrhagic transformation (HT) is one of the complications most likely to lead to death in patients with acute ischemic stroke. HT after acute ischemic stroke is diagnosed when certain areas of cerebral infarction appear as cerebral hemorrhage on radiological images. Its mechanisms are usually explained by disruption of the blood-brain barrier and reperfusion injury that causes leakage of peripheral blood cells. In ischemic infarction, HT may be a natural progression of acute ischemic stroke and can be facilitated or enhanced by reperfusion therapy. Therefore, to balance risks and benefits, HT occurrence in acute stroke settings is an important factor to be considered by physicians to determine whether recanalization therapy should be performed. This review aims to illustrate the pathophysiological mechanisms of HT, outline most HT-related factors after reperfusion therapy, and describe prevention strategies for the occurrence and enlargement of HT, such as blood pressure control. Finally, we propose a promising therapeutic approach based on biological research studies that would help clinicians treat such catastrophic complications.
症状性出血转化（HT）是急性缺血性脑卒中患者最有可能导致死亡的并发症之一。急性缺血性脑卒中后的HT是指当脑梗死的某些区域在影像学图像上表现为脑出血时被诊断出来。其机制通常用血脑屏障破坏和导致外周血细胞渗漏的再灌注损伤来解释。在缺血性梗死中，HT可能是急性缺血性脑卒中的自然进展，再灌注治疗可促进或加重这种情况。因此，为了平衡风险和益处，急性卒中情况下HT的发生是医生在决定是否应进行再通治疗时需要考虑的一个重要因素。本综述旨在阐述HT的病理生理机制，概述再灌注治疗后大多数与HT相关的因素，并描述HT发生和扩大的预防策略，如血压控制。最后，我们基于生物学研究提出一种有前景的治疗方法，这将有助于临床医生治疗此类灾难性并发症。
