A174 Precision packing: a volumetric imaging approach to sizing endosaccular devices for axial stability in intracranial aneurysms

<h3>Introduction</h3> To evaluate a volumetric imaging-based sizing strategy for the Artisse device and explore its generalizability to other intrasaccular implants with adjusted compression thresholds. <h3>Aim of study</h3> Patients with wide-neck aneurysms treated with the Artisse device were retrospectively analyzed. Aneurysm sac volumes were calculated using 3D rotational angiography and segmentation. Final device size was compared to volume-based recommendations tailored to the device’s compression profile. Procedural performance, packing conformance, and early occlusion (mRRC/WOS score) were evaluated. <h3>Method</h3> Patients with wide-neck aneurysms treated with the Artisse device were retrospectively analyzed. Aneurysm sac volumes were calculated using 3D rotational angiography. Final device size was selected based on volume-derived targets adjusted for Artisse’s compression profile. Procedural performance, packing conformance, and early occlusion (mRRC score) were assessed. Follow-up evaluated compaction or incomplete occlusion. <h3>Results</h3> Twelve aneurysms were treated, including five ruptured cases. Volumetric sizing was used prospectively to avoid undersizing. The median compression rate achieved was 25%, aligning with the target for axial stability. All but one devices were successfully deployed without repositioning. Early follow-up showed complete or near-complete occlusion (mRRC 1–2) in most cases, with no early compaction observed. The method is adaptable to other devices by adjusting for their compression characteristics. <h3>Conclusion</h3> Volumetric sizing provides a personalized, geometry-based strategy for intrasaccular device selection. By targeting compression ratios essential for axial stability, it may improve outcomes and durability. Sizing principles will be presented to support broader neurointerventional adoption. <h3>Conflict of Interest</h3> No