MCP-Net: Real-Time Coronary Perception Network and Topological Analysis for Robotic Guidewire Navigation

Robotic-assisted percutaneous coronary intervention (PCI) is constrained by the inherent limitations of 2D Digital Subtraction Angiography (DSA). Unlike physicians, who can directly manipulate guidewires and integrate tactile feedback with their prior anatomical knowledge, teleoperated robotic systems must rely solely on 2D projections. This mode of operation, simultaneously lacking spatial context and tactile sensation, may give rise to projection-induced ambiguities at vascular bifurcations. To address this challenge, we propose a two-stage framework (SCAR-UNet-GAT) for real-time robotic path planning. In the first stage, SCAR-UNet, a spatial-coordinate-attention-regularized U-Net, is employed for accurate coronary vessel segmentation. The integration of multi-level attention mechanisms enhances the delineation of thin, tortuous vessels and improves robustness against imaging noise. From the resulting binary masks, vessel centerlines and bifurcation points are extracted, and geometric descriptors (e.g., branch diameter, intersection angles) are fused with local DSA patches to construct node features. In the second stage, a Graph Attention Network (GAT) reasons over the vessel graph to identify anatomically consistent and clinically feasible trajectories, effectively distinguishing true bifurcations from projection-induced false crossings. On a clinical DSA dataset, SCAR-UNet achieved a Dice coefficient of 93.1%. For path disambiguation, the proposed GAT-based method attained a success rate of 95.0% and a target-arrival success rate of 90.0%, substantially outperforming conventional shortest-path planning (60.0% and 55.0%) and heuristic-based planning (75.0% and 70.0%). Validation on a robotic platform further confirmed the practical feasibility and robustness of the proposed framework.

Coronary guidewire endpoint localization is a fundamental capability for computer-assisted PCI, and its importance increases as robot-assisted PCI is progressively adopted to reduce operator radiation exposure. However, the scarcity of annotated CAG images with guidewires and the limited adaptability of existing guidewire synthesis models remain key bottlenecks for guidewire endpoint localization. To address this issue, we propose VDSB-GWSyn, a Diffusion Schrödinger Bridge (DSB) model-based framework, enabling synthesis of controllable, high-fidelity guidewire samples under complex anatomical backgrounds. VDSB-GWSyn first uses our shape prior algorithm to learn the basic guidewire geometry. It then generates guidewire masks under constraints imposed by the vessel segmentation masks and outputs the corresponding endpoint coordinates. Finally, it synthesizes realistic guidewire samples on real CAG images using DSB conditioned with SPADE. Experimental results show that the guidewire samples synthesized by VDSB-GWSyn achieve favorable ROI-FID and ROI-KID, as well as high IPR scores. In addition, incorporating our synthesized data for synthetic pre-training followed by real fine-tuning substantially improves downstream guidewire endpoint localization, reducing MPE from 16.01px to 7.71px and increasing PCK at 3~px from 52.63% to 86.27%, leading to more clinically reliable deployment of robot-assisted guidewire delivery systems. Moreover, the core design philosophy of controllable device synthesis with strict background preservation and anatomical feasibility constraints has the potential to transfer to other interventional device perception tasks where annotated data are scarce.

Conventional pixel-wise loss functions fail to enforce topological constraints in coronary vessel segmentation, producing fragmented vascular trees despite high pixel-level accuracy. We present ARIADNE, a two-stage framework coupling preference-aligned perception with RL-based diagnostic reasoning for topologically coherent stenosis detection. The perception module employs DPO to fine-tune the Sa2VA vision-language foundation model using Betti number constraints as preference signals, aligning the policy toward geometrically complete vessel structures rather than pixel-wise overlap metrics. The reasoning module formulates stenosis localization as a Markov Decision Process with an explicit rejection mechanism that autonomously defers ambiguous anatomical candidates such as bifurcations and vessel crossings, shifting from coverage maximization to reliability optimization. On 1,400 clinical angiograms, ARIADNE achieves state-of-the-art centerline Dice of 0.838, reduces false positives by 41% compared to geometric baselines. External validation on multi-center benchmarks ARCADE and XCAD confirms generalization across acquisition protocols. This represents the first application of DPO for topological alignment in medical imaging, demonstrating that preference-based learning over structural constraints mitigates topological violations while maintaining diagnostic sensitivity in interventional cardiology workflows.