Discrepancies in computed tomography (CT) perfusion and CT angiography imaging following stroke in a patient post-heart transplant on extracorporeal membrane oxygenation: a case report

Background: Extracorporeal membrane oxygenation (ECMO) is a critical life-support intervention for severe cardiopulmonary failure. Venoarterial (VA)-ECMO presents unique challenges in neuroradiological assessment due to hemodynamic alterations and the presence of imaging artifacts. Case Report: This case report describes an adult post-heart transplant patient on peripheral VA-ECMO who developed left-sided hemiparesis, suggestive of cerebrovascular events. While our patient developed multifocal ischemic infarcts, the initial computed tomography perfusion (CTP) imaging indicated hypoperfusion of the entire right hemisphere. Given the discrepancy in the patient’s clinical assessment, which was suggestive of a more circumscribed right hemispheric involvement, and the CTP findings, subsequent digital subtraction angiography was performed, which demonstrated adequate vascular filling with no large vessel occlusion. Conclusion: These findings highlight the diagnostic complexities of ECMO-related artifacts, even in the presence of neurological complications that can mimic true perfusion deficits and potentially lead to misdiagnosis.