Abstract: Systems and methods disclosed herein provide a method for real-time PCI guidance. A method comprises receiving one or more images of a blood vessel from an imaging modality system, the blood vessel having a lumen, a lumen surface, and a wall; building a 3D model of the blood vessel based on the one or more images; segmenting one or more materials between the lumen and the wall of the blood vessel; reconstructing the blood vessel based on the one or more images; assigning material properties to the reconstructed surface of the blood vessel; determining a wall thickness, a plaque thickness, a lumen area, a plaque eccentricity and one or more plaque constituents; guiding an interventional procedure in real-time based on the 3D reconstructed vessel lumen surface and segmented materials; and performing balloon pre-dilation, a percutaneous coronary intervention, and balloon post-dilation with the 3D reconstructed vessel lumen surface and segmented materials.