Complete cohort - Case 11 of 83
Case 14
Assigned out-of-fold recommendation
Stent-assisted coil embolization
Alternative: Flow disruption (intra-saccular)
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 54-year-old male presents with an incidental, irregular saccular aneurysm located at the left M1 bifurcation.
Image observation
On the supplied views, a saccular outpouching appears at the M1 bifurcation with a visible neck and adjacent branching vessels.
Model-generated clinical rationale
The assigned recommendation of stent-assisted coil embolization is supported by the documented irregular morphology and the presence of daughter lobules at the aneurysm neck, which may necessitate a stent to maintain coil stability. However, the recommendation is limited by the lack of specific neck width measurements, which are critical for determining the necessity of stent assistance versus other techniques.
Model uncertainty
The OOF score distribution was diffuse: Stent-assisted coil embolization ranked first, but Flow disruption (intra-saccular) remained a material alternative.
Clinical uncertainty / missing factor
The specific neck-to-dome ratio and precise neck width are not documented, creating uncertainty regarding the feasibility of stent placement versus flow disruption.
Explicit evidence used
irregular saccular aneurysm | multiple daughter lobules, largest at the aneurysm neck