Caveats to Acute Imaging for Acute Stroke in the Setting of Venoarterial Extracorporeal Membrane Oxygenation

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for cardiorespiratory support in medically refractory cases. The high rate of neurologic complications, specifically cerebrovascular disorders such as acute ischemic stroke, in VA-ECMO patients frequently prompts the acquisition of neuroimaging studies such as computed tomography with angiography and perfusion imaging (CTA and CTP). Clinicians must be familiar with the ECMO-related artifacts when interpreting such studies. Here we describe a case of asymmetric contrast opacification in a VA-ECMO patient with axillary artery cannulation.