Complete cohort - Case 31 of 83
Case 38
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Flow diversion alone
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 58-year-old woman presents with an unruptured 7.9mm x 3.8mm x 4.6mm aneurysm with a 3.6mm neck located at the right A1-A2 junction.
Image observation
On the supplied views, a saccular outpouching appears at the anterior cerebral artery junction with visible contrast filling the aneurysm sac.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented 3.6mm neck width, which may allow for adequate coil retention. However, the aneurysm's location at the A1-A2 junction presents a potential challenge for maintaining patency of the A2 segment during packing. The rationale is limited by the lack of explicit documentation regarding the specific angle of the neck or the presence of perforators that might necessitate adjunctive balloon or stent assistance.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Flow diversion alone remained a material alternative.
Clinical uncertainty / missing factor
The most significant missing decision factor is the precise morphological relationship between the aneurysm neck and the A2 origin, which determines the feasibility of simple coiling versus the need for flow diversion or stent assistance.
Explicit evidence used
7.9mm x 3.8mm x 4.6mm aneurysm with 3.6mm neck | Right A1-A2 junction location