Complete cohort - Case 13 of 83
Case 16
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 63-year-old female presented with aneurysmal subarachnoid hemorrhage (HH3mF4) caused by a ruptured left superior cerebellar artery aneurysm.
Image observation
On the supplied views, the left superior cerebellar artery aneurysm appears as a laterally projecting saccular outpouching at the vessel origin.
Model-generated clinical rationale
The pre-treatment narrative documents the aneurysm as a 4.2mm x 2.5mm x 2.3mm elongated, irregular saccular lesion. While the small dimensions and saccular morphology are generally amenable to coil embolization alone, the reported irregularity and elongated shape may complicate coil packing stability. The recommendation for simple coiling is limited by the lack of explicit documentation regarding the neck width or the presence of incorporated branches that might necessitate adjunctive stenting.
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 most critical missing decision factor is the precise neck-to-dome ratio and the presence of any incorporated branch vessels, which are not explicitly quantified in the narrative.
Explicit evidence used
4.2mm x 2.5mm x 2.3mm elongated, irregular laterally projected saccular aneurysm | Ruptured left superior cerebellar artery aneurysm