Small particle polyvinyl alcohol embolization of cranial lesions with minimal arteriolar-capillary barriers

Polyvinyl alcohol foam, prepared as small particles measuring 70-150 micron when injected in intracerebral arteries of the rat, adhere to the vascular endothelium, allowing the particles to be captured without necessarily wedging intraluminally. Based on this observation, small particle microembolization was performed in a series of patients who had hypervascular cranial lesions, whose matrices angiographically appeared to have at best minimal arteriolar-capillary barriers. Each case was associated with intracranial dural sinus or cerebral venous drainage. In addition, several lesions had either venous ectasia or venous aneurysms. Symptomatic improvement occurred in all cases without apparent neurologic or pulmonary complications. These examples demonstrate the ability of very small polyvinyl alcohol foam particles to remain within the interstices of vascular lesions that display evidence of only minimal arteriolar-capillary barriers.