Complete cohort - Case 10 of 83
Case 13
Assigned out-of-fold recommendation
Flow diversion with coil embolization
Alternative: Stent-assisted coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 54-year-old female presented with an incidentally discovered, unruptured 11.2 mm right internal carotid artery aneurysm with a 5.2 mm neck.
Image observation
On the supplied views, a large saccular aneurysm appears to project dorsally from the internal carotid artery, with the parent vessel and distal branches opacifying normally.
Model-generated clinical rationale
The assigned recommendation of flow diversion with coil embolization is supported by the aneurysm's large size and wide neck, which may complicate standard coiling. However, the dorsal projection and lack of visualized communicating arteries limit the assessment of collateral flow and potential branch incorporation.
Model uncertainty
The OOF classifier scores for Flow diversion with coil embolization and Stent-assisted coil embolization were close, so the assigned recommendation should be treated as uncertain.
Clinical uncertainty / missing factor
The most significant missing decision factor is the status of the anterior and posterior communicating arteries, which were not visualized and are critical for determining collateral safety.
Explicit evidence used
11.2 mm x 8.9 mm x 7.1 mm aneurysm with 5.2 mm neck | Anterior and posterior communicating arteries are not visualized