Complete cohort - Case 22 of 83
Case 26
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Balloon-assisted coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 68-year-old female presented for elective treatment of a left unruptured ophthalmic aneurysm.
Image observation
On the supplied views, the aneurysm appears as a bilobed outpouching arising from the internal carotid artery, with the ophthalmic artery origin appearing separate from the aneurysm sac.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented separation of the ophthalmic artery origin, which minimizes the risk of branch occlusion during packing. However, the reported 3.9 mm neck width suggests a wide-necked morphology that may challenge coil stability without adjunctive balloon assistance.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Balloon-assisted coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The most significant missing decision factor is the precise neck-to-dome ratio and the exact angle of the ophthalmic artery takeoff, which are critical for determining the necessity of balloon remodeling.
Explicit evidence used
Left unruptured ophthalmic aneurysm | Ophthalmic artery origin is separate from the aneurysm | Neck measuring 3.9 mm