Complete cohort - Case 8 of 83
Case 11
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Stent-assisted coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 66-year-old male presents for treatment of a known unruptured left MCA bifurcation aneurysm measuring approximately 10 x 8.4 x 11 mm with a 4.4 mm neck.
Image observation
On the supplied views, a saccular aneurysm appears at the MCA bifurcation with contrast filling the adjacent branch vessels.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented 4.4 mm neck width, which may allow for primary coil packing without adjunctive devices. However, the large aneurysm dimensions and bifurcation location present a risk of coil prolapse or incomplete occlusion, which limits the certainty of this approach.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Stent-assisted coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The specific morphology of the aneurysm neck and the exact angle of the bifurcation branches are not fully characterized, which are critical factors for determining the feasibility of coil-only treatment.
Explicit evidence used
Unruptured left MCA bifurcation aneurysm | Aneurysm dimensions 10 x 8.4 x 11 mm with 4.4 mm neck