Complete cohort - Case 26 of 83
Case 30
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
The patient presents with a 3 mm x 2 mm x 3 mm right MCA bifurcation aneurysm with a 1.8 mm neck, from which an M2 branch arises at the base.
Image observation
On the supplied views, the right MCA bifurcation aneurysm appears as a distinct outpouching with a visible branch vessel arising from its base.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the aneurysm's small dimensions and the presence of a defined neck. However, the documented origin of an M2 branch from the aneurysm base presents a significant challenge for simple coiling, as it risks branch occlusion or requires complex navigation. The absence of explicit documentation regarding the branch's criticality or the aneurysm's specific morphological shape limits the certainty of this recommendation.
Model uncertainty
The OOF classifier showed a relatively clear preference for Coil embolization alone over Stent-assisted coil embolization, but its scores are not probabilities of clinical correctness.
Clinical uncertainty / missing factor
The most critical missing decision factor is the clinical significance of the M2 branch arising from the aneurysm base and whether its preservation necessitates adjunctive stenting.
Explicit evidence used
Right MCA bifurcation aneurysm 3 mm x 2 mm x 3 mm with 1.8 mm neck | M2 branch arises from the base of the aneurysm