Complete cohort - Case 49 of 83
Case 58
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
A 67-year-old female presents with an incidentally discovered 3.7 x 4.1 x 4.9 mm left MCA bifurcation aneurysm with a 4.5-mm neck.
Image observation
On the supplied views, a saccular outpouching appears at the MCA bifurcation with contrast opacification of the parent vessel and distal branches.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is limited by the documented 4.5-mm neck width, which suggests a wide-necked morphology that may require adjunctive support. The narrative notes the aneurysm apparently incorporates the origin of the inferior division MCA, a feature that complicates simple coiling and increases the risk of branch occlusion. Without explicit documentation of the neck-to-dome ratio or specific branch angles, the feasibility of standalone coiling remains questionable.
Model uncertainty
The OOF classifier scores for Coil embolization alone and Stent-assisted coil embolization were close, so the assigned recommendation should be treated as uncertain.
Clinical uncertainty / missing factor
The most critical missing decision factor is the precise geometric relationship between the aneurysm neck and the incorporated inferior division branch, which determines the necessity for stent assistance.
Explicit evidence used
3.7 x 4.1 x 4.9 mm aneurysm with 4.5-mm neck | Incorporation of the origin of the inferior division MCA