Why would ITX card be 2 slot and not 1 slot ? :>Well if you look at it sensibly it seems to me that standardising card length to motherboards would make sense. That way you can make efficient cases.
So "ITX" cards would be 170mm/2 slot
"micro/ATX" cards would be 244mm/4 slot
and "eATX" cards would be 330mm/7 slot
The 5090 shows that you can dissipate a lot of heat in a 2 slot card if there's a lot of vent through area, and there's an awesome example of how it can be done cheaper, done by gigabyte:
So in essence, if you squeeze everything upfront, you can have a huge pass-through area after the PCB. 5090 overcomplicates this thing a lot, but I get that they wanted to extract heat both sides.
Anyway 2-slot designs can do enough to tackle mainstream chips up to 250W of reference size and something between 10.5~12" / 267~305mm.
10.5"/267mm is IMO minimum length that makes sense for the card to have a stealth connector on the bottom side of the card that will go around 244mm of ATX/mATX to be hidden by directly going into the grommet pass-through to the back of the case where cable management is done.
Apart from this some standardised ITX sized and low profile ITX sized also make sense, but having mid-range chips is either impossible or loud, but for lower end ones, they are still valid and make much sense.