Hemorrhagic transformation (HT) is a common complication after thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in ischemic stroke. In this article, recent research progress of HT in vivo and in vitro studies was reviewed. We have discussed new potential mechanisms and possible experimental models of HT development, as well as possible biomarkers and treatment methods. Meanwhile, we compared and analyzed rodent models, large animal models and in vitro BBB models of HT, and the limitations of these models were discussed. The molecular mechanism of HT was investigated in terms of BBB disruption, rt-PA neurotoxicity and the effect of neuroinflammation, matrix metalloproteinases, reactive oxygen species. The clinical features to predict HT were represented including blood biomarkers and clinical factors. Recent progress in neuroprotective strategies to improve HT after stroke treated with rt-PA is outlined. Further efforts need to be made to reduce the risk of HT after rt-PA therapy and improve the clinical prognosis of patients with ischemic stroke.

出血性转化 (HT) 是缺血性卒中患者使用重组组织型纤溶酶原激活剂 (rt-PA) 溶栓后的常见并发症。本文综述了HT体内和体外研究的最新研究进展。我们讨论了 HT 发展的新潜在机制和可能的实验模型，以及可能的生物标志物和治疗方法。同时，我们比较分析了啮齿动物模型、大型动物模型和体外模型。讨论了 HT 的 BBB 模型，以及这些模型的局限性。从 BBB 破坏、rt-PA 神经毒性和神经炎症、基质金属蛋白酶、活性氧物质的影响等方面研究了 HT 的分子机制。预测 HT 的临床特征包括血液生物标志物和临床因素。概述了用 rt-PA 治疗中风后改善 HT 的神经保护策略的最新进展。需要进一步努力降低 rt-PA 治疗后发生 HT 的风险，改善缺血性卒中患者的临床预后。