Complete cohort - Case 83 of 83
Case 100
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Balloon-assisted coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 56-year-old female presents with aneurysmal subarachnoid hemorrhage due to a ruptured left posterior communicating artery aneurysm.
Image observation
On the supplied views, a saccular aneurysm with a visible daughter lobe appears to arise from the left internal carotid artery.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented 2.8 mm neck width, which suggests a geometry potentially amenable to primary coiling. However, the presence of a daughter lobe and the ruptured status of the aneurysm introduce complexity regarding coil stability and the risk of recurrence. The recommendation appears questionable given the potential need for adjunctive balloon support to secure the neck, a factor not fully resolved by the available data.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Balloon-assisted coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The most significant missing decision factor is the precise morphological assessment of the neck-to-dome ratio and the exact relationship of the aneurysm to the posterior communicating artery origin, which determines the necessity for balloon assistance.
Explicit evidence used
Ruptured left PCOM aneurysm | Dimensions 6.5 mm x 4.7 mm with 2.8 mm neck