In silico comparison of two non-invasive pre-procedural virtual coronary revascularisation techniques for personalised cardiovascular medicine

Background and objectives: Non-invasive pre-procedural prediction of post-PCI vessel morphology and CT angiography–derived fractional flow reserve (CT-FFR) can inform coronary revascularisation planning. However, the capabilities of different CT-based virtual coronary revascularisation (VCR) techniques need further investigation. Methods: This study compared two CT-based VCR techniques: a virtual coronary intervention (VCI) method and a radius correction (RC) method. The two techniques applied to 9 vessel cases were examined according to the accuracy of luminal cross-section area, luminal centreline curvature and predicted post-PCI CT-FFR. Post-PCI computed tomography angiography reference standard were used for further validation. Results: The measured post-PCI cross-sectional area was 18.74 ± 4.30 mm². The VCI-predicted area was 17.29 ± 3.48 mm² (mean difference: −1.45 ± 1.96 mm²; limits of agreement: −5.29 to 2.38), whereas the RC-predicted area was 9.42 ± 1.30 mm² (mean difference: −9.32 ± 3.78 mm²; limits of agreement: −16.72 to −1.92). The measured post-PCI centreline curvature was 0.16 ± 0.02 mm^-1. VCI predicted 0.15 ± 0.04 mm⁻¹ (mean difference: −0.01 ± 0.05 mm⁻¹; limits of agreement: −0.12 to 0.09), whereas RC predicted 0.24 ± 0.07 mm⁻¹ (mean difference: 0.08 ± 0.07 mm⁻¹; limits of agreement: −0.05 to 0.21). The post-PCI CCTA-derived CT-FFR (functional reference) was 0.92 ± 0.09. VCI predicted 0.90 ± 0.08 (mean difference: −0.02 ± 0.03; limits of agreement: −0.08 to 0.04) and RC predicted 0.90 ± 0.06 (mean difference: −0.02 ± 0.05; limits of agreement: −0.12 to 0.09). Conclusions: Both non-invasive, pre-procedural techniques showed good numerical agreement with computational post-PCI CT-FFR in this pilot cohort. However, the VCI method outperformed the RC method in predicting luminal cross-sectional area and luminal centreline curvature. The cross-sectional area of the stented vessel was underestimated, and the average curvature was overestimated in the RC method.