Complete cohort - Case 57 of 83
Case 72
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Balloon-assisted coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 59-year-old female presents with an unruptured 4.6x4.5x3.8mm right posterior communicating artery aneurysm with a 2.2mm neck and a small P-comm artery originating from the proximal neck.
Image observation
On the supplied views, a saccular outpouching appears at the posterior communicating artery junction with a visible neck and adjacent branching vessel.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented 2.2mm neck width, which suggests a geometry potentially amenable to endosaccular packing without adjunctive devices. However, the presence of a small P-comm artery arising from the proximal neck introduces a risk of branch occlusion that may necessitate balloon assistance for protection, a factor not fully resolved by the current documentation.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Balloon-assisted coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The critical missing decision factor is the precise spatial relationship between the aneurysm neck and the origin of the small P-comm artery, which determines the necessity of balloon protection.
Explicit evidence used
4.6x4.5x3.8mm saccular aneurysm | 2.2 mm neck | Small P-comm artery originates from the proximal neck