A Diffusion Model for Simulation Ready Coronary Anatomy with Morpho-skeletal Control

Virtual interventions enable the physics-based simulation of device deployment within patient-specific coronary artery anatomy. This framework enables the exploration of alternate scenarios by deploying counterfactual device designs within the same anatomy, revealing critical design factors for patient outcomes. In contrast, our ability to simulate alternate scenarios with anatomic counterfactuals is highly limited. In this study, we investigate how Latent Diffusion Models (LDMs) can custom synthesize coronary anatomy for virtual intervention studies. We introduce several adaptations to enforce anatomic constraints regarding topological validity, local morphological shape, and global skeletal structure. Specifically, we regularize the LDM latent space to reduce topological defects and introduce a conditioning framework based on clinically interpretable and editable coronary morpho-skeletons. We lastly extend diffusion model guidance strategies to the context of morpho-skeletal conditioning and propose a novel guidance method that adaptively updates the guiding condition throughout sampling. Our framework enables the generation and editing of coronary anatomy in a controllable manner, allowing device designers to better explore the relationship