Height-preserving sizing method for the new Artisse intrasaccular device based on early findings from 26 cases of intracranial aneurysm embolization.

Abstract

With the recent relaunch of Artisse 2.0, optimal sizing strategies for the device are still being refined. The official sizing chart covers only taller-than-wide aneurysms within a limited diameter range of 3.4-6 mm. To expand its applicability, we propose an intuitive sizing strategy emphasizing the importance of preserving the device's natural height. Patients treated with the Artisse 2.0 between November 2022 and October 2024 were retrospectively analyzed. Among 26 aneurysms treated over a 24-month period, 13 exhibited varying degrees of 'dog-ear' formation on post-deployment imaging. These cases showed greater width oversizing (+2.06 vs +1.29 mm, P<0.05) and height reduction (-1.83 vs -0.53 mm, P<0.05) compared with cases with complete neck coverage. Similarly, 9 out of the 16 aneurysms with at least one surveillance imaging failed to achieve complete angiographic occlusion. These cases were also associated with greater width oversizing (+1.72 vs +1.43 mm, P=0.47) and height reduction (-2.18 vs -0.81 mm, P=0.052). In contrast to the Woven EndoBridge (WEB) device, excessive lateral compression and height reduction appear to undermine the stability of the Artisse 2.0. As a result, the device size for spherical or ovoid aneurysms can be determined using the '+1/-1' method, while the '+1/-0' approach is recommended for cylindrical aneurysms to improve neck coverage through height preservation. These proposed sizing strategies may serve as a practical interim solution until more clinical data and user experience become available.