VeCAS: Vessel-Focused Contrast-Free Angiogram Synthesis for Vascular Interventions

X-ray angiography relies on iodinated contrast agents to visualize vascular structures during image-guided interventions. However, contrast administration carries risks of adverse events, motivating the development of contrast-free alternatives. Generating X-ray angiograms directly from non-contrast X-ray images offers a potential solution, but existing approaches remain limited by (i) insufficient control over vascular localization and (ii) inefficient modeling of redundant background content. To address these challenges, we propose VeCAS, a two-stage vessel-focused contrast-free angiogram synthesis framework that separates vascular structure localization from angiographic appearance synthesis. In Stage I, a discriminative model localizes vascular structures in non-contrast X-ray images, while cross-modality latent distillation transfers vessel-sensitive knowledge from X-ray angiograms during training. In Stage II, a vessel-focused inpainting model synthesizes angiographic appearance within the localized vascular regions while preserving the non-vascular background. Experiments on an in-house lower-limb vascular intervention dataset show that VeCAS outperforms the comparison methods in terms of vascular structural fidelity and image quality. Visual Turing tests and physician assessments indicate the perceptual realism of the synthesized angiograms. In addition, robotic guidewire navigation experiments in vascular phantoms show that VeCAS guidance reduces the time to target by 41.4% and the number of operation steps by 40.7% compared with non-contrast guidance. Together, these results suggest the potential of VeCAS to serve as ``meta contrast agent'' for vascular interventions.