Complete cohort - Case 50 of 83
Case 59
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 43-year-old woman presents for treatment of an unruptured left anterior choroidal artery aneurysm measuring 3.1 x 3.6 x 5.9 mm with a 1.3 mm neck and irregular morphology.
Image observation
On the supplied views, a saccular outpouching appears to arise from the supraclinoid internal carotid artery, with the anterior choroidal artery origin visible in proximity to the aneurysm neck.
Model-generated clinical rationale
The assigned recommendation of stent-assisted coil embolization is likely driven by the documented irregular morphology and the 1.3 mm neck width, which may pose challenges for coil retention. However, the small aneurysm dimensions and the critical proximity of the anterior choroidal artery origin limit the feasibility of stenting due to the risk of branch occlusion.
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 spatial relationship between the aneurysm neck and the anterior choroidal artery origin is the most critical missing factor for determining the safety of stent placement.
Explicit evidence used
Aneurysm measures 3.1 mm x 3.6 mm x 5.9 mm with a 1.3 mm neck | Irregular morphology with a 1 mm Murphy's excrescence