Complete cohort - Case 46 of 83
Case 55
Assigned out-of-fold recommendation
Stent-assisted coil embolization
Alternative: Coil embolization alone
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 53-year-old female presents with an incidental, irregular saccular aneurysm at the basilar apex measuring 7.5 mm x 7 mm x 5.7 mm.
Image observation
On the supplied views, a saccular outpouching appears at the basilar apex with a superiorly projected excrescence at the dome.
Model-generated clinical rationale
The assigned recommendation of stent-assisted coil embolization is likely driven by the documented irregular morphology and the presence of a Murphy's excrescence, which may complicate coil retention. However, the narrative describes normal bilateral posterior cerebral arteries, and the images do not explicitly confirm a wide neck or branch incorporation that would strictly mandate stenting.
Model uncertainty
The OOF score distribution was diffuse: Stent-assisted coil embolization ranked first, but Coil embolization alone remained a material alternative.
Clinical uncertainty / missing factor
The precise neck-to-dome ratio and the exact relationship of the excrescence to the parent vessel lumen are not quantified, limiting the ability to definitively rule out simple coiling.
Explicit evidence used
Irregular saccular aneurysm at basilar apex | Superiorly projected Murphy's excrescence