Complete cohort - Case 54 of 83
Case 64
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
An 82-year-old female presents with an incidentally discovered, unruptured 6.8mm left PCOM artery aneurysm with a 3.8mm neck.
Image observation
On the supplied views, a saccular outpouching appears at the origin of the posterior communicating artery, with the parent vessel and adjacent vasculature visible.
Model-generated clinical rationale
The assigned recommendation of stent-assisted coil embolization is supported by the documented 3.8mm neck width, which may necessitate a stent to maintain coil stability. However, the presence of a small PCOM artery and the patient's advanced age (82) introduce significant clinical complexity regarding the necessity of dual antiplatelet therapy and 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 most critical missing decision factor is the patient's clinical frailty and tolerance for the dual antiplatelet therapy required for stent placement.
Explicit evidence used
6.8mm x 5.2mm x 6.1mm left PCOM artery aneurysm with a 3.8mm neck | 82 year old female | small PCOM artery