Complete cohort - Case 74 of 83
Case 89
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
The patient presents with a recanalized right anterior temporal artery aneurysm containing a residual sac and a branch vessel arising from the aneurysm base.
Image observation
On the supplied views, a residual aneurysm sac appears to contain a dense coil mass, with a branch vessel arising from the base of the treated segment.
Model-generated clinical rationale
The assigned recommendation of stent-assisted coil embolization is supported by the presence of a branch vessel arising from the aneurysm base, which may require a stent to preserve patency during retreatment. However, the residual neck is small (2-3 mm), which might otherwise allow for simple coiling. The recommendation appears questionable without explicit documentation of the neck width or the specific risk of branch occlusion.
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 important missing decision factor is the precise neck-to-dome ratio and the critical necessity of stenting to protect the anterior temporal artery branch.
Explicit evidence used
recanalized aneurysm with residual sac | anterior temporal artery arises from the residual sac base