Complete cohort - Case 28 of 83
Case 32
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 61-year-old female presented with an asymptomatic, unruptured left superior cerebellar artery aneurysm measuring 2.8 mm x 2.3 mm with a 1.7 mm neck.
Image observation
On the supplied views, the posterior circulation vasculature appears patent with a visible aneurysmal outpouching at the origin of the superior cerebellar artery.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the aneurysm's small dimensions and the documented 1.7 mm neck, which may allow for primary coil packing. However, the relatively wide neck-to-dome ratio suggests that coil stability might be compromised without adjunctive balloon assistance. The recommendation appears questionable given the potential need for neck remodeling to prevent coil prolapse.
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 3D morphological assessment of the neck geometry and the exact angle of the aneurysm relative to the parent vessel, which are critical for determining coil retention.
Explicit evidence used
2.8 mm x 2.3 mm aneurysm dimensions | 1.7 mm neck width