Complete cohort - Case 40 of 83
Case 49
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Flow diversion with coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 70-year-old female presents with an unruptured 8.7 x 5.9 x 5.6 mm broad-based right V4 vertebral artery aneurysm involving the entire parent vessel.
Image observation
On the supplied views, a saccular outpouching appears to arise from the vertebral artery with the PICA origin visible proximal to the lesion.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the aneurysm's broad-based morphology and the documented preservation of the PICA origin proximal to the sac. However, the involvement of the entire parent vessel and diffuse atherosclerotic disease may limit the stability of coils without adjunctive support.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Flow diversion with coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The precise neck-to-dome ratio and the exact angle of the PICA origin relative to the aneurysm neck are not explicitly quantified, which are critical factors for determining the feasibility of coil-only treatment versus flow diversion.
Explicit evidence used
8.7 x 5.9 x 5.6 mm broad based aneurysm | Right PICA origin is proximal to aneurysm