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Introduction The combination of intrasaccular devices and coiling may extend the indications for intrasaccular treatment strategies by improving their effectiveness in challenging aneurysm anatomies. The novel Single Implant for Sidewall Aneurysms (SISA) is an intrasaccular implant featuring a flow-impermeable membrane at its base. A unique catheter-like pusher system enables the delivery of additional coils into the aneurysm following device deployment.Aim of study The aim of this proof-of-concept study was to evaluate the technical feasibility, handling characteristics, and efficacy of the novel SISA device.Method In parallel with the development phase prototypes were tested in patient-specific 3D printed models of large internal carotid artery sidewall aneurysms. Subsequently, in vivo evaluation was conducted in rabbit sidewall and bifurcation aneurysms, including angiographic follow-up and histopathological analysis at 30 or 90 days.Results A total of 15 complete systems were tested—nine in vitro and six in vivo. In the challenging anatomy of sidewall aneurysms, the implants achieved immediate and effective neck sealing. With adjunctive coiling residual inflow jets remained stable or regressed after 30 and 90 days follow-up. Accurate coil delivery through the device base into the aneurysm proved essential. Histopathology analysis confirmed good biocompatibility.Conclusion SISA demonstrates that the novel combination of intrasaccular flow diversion and adjunctive coiling via a single catheter-like pusher system is technically feasible. First in vivo evaluation demonstrated promising results regarding safety and efficacy. Further studies are needed to confirm these results.Conflict of Interest No