Complete cohort - Case 25 of 83
Case 29
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 49-year-old male presents for treatment of an incidental, unruptured 3.6 x 3.0 x 3.3 mm saccular aneurysm arising from the right ophthalmic segment of the internal carotid artery.
Image observation
On the supplied views, a cranially oriented saccular outpouching appears at the supraclinoid internal carotid artery, with the ophthalmic artery origin visible in proximity.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the aneurysm's small size and saccular morphology. However, the documented neck width of 3.1 mm is wide relative to the dome dimensions, which may limit the stability of coils without adjunctive support. The recommendation appears questionable given the wide-neck geometry, as this feature often necessitates stent assistance to prevent coil prolapse.
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 significant missing decision factor is the precise neck-to-dome ratio and the exact angle of the ophthalmic artery origin relative to the aneurysm neck, which are critical for determining coil stability.
Explicit evidence used
Unruptured aneurysm arising from the right ophthalmic segment | Aneurysm dimensions 3.6 x 3.0 x 3.3 mm with a 3.1 mm neck