Complete cohort - Case 69 of 83
Case 84
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 72-year-old male with subarachnoid hemorrhage presents with a 5.0 x 2.2 x 2.8 mm saccular anterior communicating artery aneurysm with a 2.3 mm neck.
Image observation
On the supplied views, the aneurysm appears as a distinct contrast-filled outpouching arising from the anterior communicating artery complex with visible filling of the surrounding anterior cerebral artery branches.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the documented aneurysm dimensions and neck width, which may allow for primary coiling. However, the irregular borders and eccentric origin described in the narrative suggest that coil stability might be challenging, potentially necessitating balloon assistance. The recommendation appears questionable without explicit documentation of the neck-to-dome ratio or 3D morphological assessment to confirm the feasibility of standalone coiling.
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 most significant missing decision factor is the precise neck-to-dome ratio and detailed 3D morphological configuration required to definitively assess the risk of coil prolapse.
Explicit evidence used
5.0 x 2.2 x 2.8 mm saccular aneurysm with 2.3 mm neck | Irregular borders and eccentric origin