Complete cohort - Case 16 of 83
Case 19
Assigned out-of-fold recommendation
Balloon-assisted coil embolization
Alternative: Coil embolization alone
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 71-year-old female presented with a subarachnoid hemorrhage caused by a right posterior communicating artery aneurysm measuring 8.8 x 6.6 x 6.7 mm.
Image observation
On the supplied views, the aneurysm appears as a large, lobulated outpouching arising from the right internal carotid artery with a large posterior communicating artery origin adjacent to the neck.
Model-generated clinical rationale
The assigned recommendation of balloon-assisted coil embolization is supported by the documented presence of prominent Murphy's excrescences and complex morphology, which may necessitate temporary neck remodeling to maintain coil stability. However, the large size of the posterior communicating artery suggests that preserving patency is critical, and the utility of balloon assistance is limited without explicit documentation of the neck-to-dome ratio.
Model uncertainty
The OOF classifier scores for Balloon-assisted coil embolization and Coil embolization alone were close, so the assigned recommendation should be treated as uncertain.
Clinical uncertainty / missing factor
The specific neck width and dome-to-neck ratio are not explicitly quantified, which is the primary anatomical factor determining the necessity of balloon assistance versus simple coiling.
Explicit evidence used
Right posterior communicating artery aneurysm measuring 8.8 x 6.6 x 6.7 mm | 2 prominent Murphy's excrescences | Large posterior communicating artery with origin arising adjacent to aneurysm neck