Complete cohort - Case 71 of 83
Case 86
Assigned out-of-fold recommendation
Flow diversion alone
Alternative: Coil embolization alone
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 63-year-old male presents for elective treatment of a 6.4 x 4.5 x 4.9 mm left internal carotid artery aneurysm with a 3 mm neck, located just proximal to the ophthalmic artery origin.
Image observation
On the supplied views, a saccular outpouching appears to arise from the lateral aspect of the supraclinoid internal carotid artery, with the ophthalmic artery origin visible in close proximity.
Model-generated clinical rationale
The assigned recommendation of flow diversion alone is supported by the aneurysm's location on the parent vessel and the presence of a 3 mm neck, which may favor parent vessel reconstruction. However, the proximity to the ophthalmic artery origin introduces complexity regarding branch preservation. The rationale is limited by the lack of explicit documentation regarding the specific angle of the ophthalmic artery takeoff relative to the aneurysm neck.
Model uncertainty
The OOF score distribution was diffuse: Flow diversion alone ranked first, but Coil embolization alone remained a material alternative.
Clinical uncertainty / missing factor
The most significant missing decision factor is the precise spatial relationship between the aneurysm neck and the ophthalmic artery origin, which determines the feasibility of flow diversion without compromising branch patency.
Explicit evidence used
Aneurysm dimensions 6.4 x 4.5 x 4.9 mm with 3 mm neck | Location proximal to ophthalmic artery origin