A New Classification Based on Angiographic Arterial Supply to Neoplasms

The extensive vascularity of extra and intracranial neoplasms is vulnerable to superselective intraarterial injection of embolic particles.1 The goal is to inject embolic material such as polyvinyl alcohol particles, gelfoam powder, fibrin glue, microfibrillar collagen, or gelatin microspheres until the vascular blush is completely obliterated. The angiographic supply pattern determines the likelihood of success of selective microcatheter placement and injection of embolic material with maximal penetration and minimal reflux into normal vasculature. A classification scheme is proposed that assigns a score from 1 to 3 (see Table 1) on the basis of angiographic appearance of the vasculature. Increasing grade suggests a higher level of complexity for embolization procedure.