Complete cohort - Case 53 of 83
Case 62
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Flow disruption (intra-saccular)
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 64-year-old female presents with an unruptured 5.8 mm x 4.8 mm broad-based aneurysm at the left middle cerebral artery bifurcation.
Image observation
On the supplied views, a saccular outpouching appears at the MCA bifurcation with contrast filling the parent vessel and adjacent branches.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the aneurysm's small size and unruptured status. However, the documented broad-based morphology and bifurcation location may complicate coil stability and limit the feasibility of this technique without adjunctive support.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Flow disruption (intra-saccular) remained a material alternative.
Clinical uncertainty / missing factor
The precise neck width and the extent of branch vessel incorporation are not explicitly quantified, which are critical factors for determining the feasibility of coil embolization alone.
Explicit evidence used
5.8 mm x 4.8 mm broad-based aneurysm | Left MCA bifurcation location