Complete cohort - Case 68 of 83
Case 83
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 59-year-old female presents with a recurrent unruptured basilar tip aneurysm measuring 5.4 x 8.5 x 8.8 mm, requiring diagnostic angiography to define morphology and collateral circulation.
Image observation
On the supplied views, a coil mass appears within the aneurysm sac, consistent with the documented recurrence, while the parent vessel and adjacent perforators appear patent.
Model-generated clinical rationale
The assigned recommendation of stent-assisted coil embolization addresses the recurrent nature of the aneurysm, where a stent may provide necessary scaffolding to prevent coil prolapse into the parent vessel. However, the rationale is limited by the lack of specific documentation regarding the aneurysm neck width or the presence of critical perforators that might contraindicate stent placement.
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 significant missing decision factor is the precise neck-to-dome ratio and the exact relationship of the aneurysm neck to the origins of the posterior cerebral arteries.
Explicit evidence used
Recurrent basilar tip aneurysm measuring 5.4 x 8.5 x 8.8 mm | Normal bilateral AICAs, SCAs, and PCAs