Complete cohort - Case 4 of 83
Case 7
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Flow diversion with coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 57-year-old female presents with an unruptured 11 x 8.6 x 6.3mm elongated irregular saccular aneurysm of the left supraclinoid internal carotid artery.
Image observation
On the supplied views, a large saccular outpouching appears to project inferomedially from the supraclinoid ICA, with a visible daughter sac near the neck.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented 4mm neck width, which suggests a geometry potentially amenable to endosaccular packing. However, the elongated and irregular morphology, combined with the presence of a daughter sac, may complicate coil stability and limit the efficacy of coiling without adjunctive support.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Flow diversion with coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The critical missing decision factor is the precise relationship between the aneurysm neck and the origin of the superior hypophyseal artery, which determines the safety of coil deployment versus the necessity of flow diversion.
Explicit evidence used
11 x 8.6 x 6.3mm elongated irregular saccular aneurysm | Neck measures approximately 4mm