The scope of this text is to critically review the most important recent advances in the field of optical coherence tomography, both from a clinical, scientific, and technical point of view.

In recent years, important steps forward have been put in the field of optimization of PCI (with a focus on optimal sizing of stents and optimization of stent expansion after implantation) and the differentiation and its possible applications of various underlying morphologic characteristics of acute coronary syndrome lesions. Several efforts have been made to elucidate underlying mechanical causes of stent thrombosis, based on optical coherence tomography (OCT) imaging. This had led to the recognition of neoatherosclerosis as an important cause for very late stent thrombosis, fueling new research into this area and to the development of intracoronary devices which could be even more safe for patients on the very long term.

With an ever increasing use for clinical and scientific applications in coronary artery disease, OCT has come to a mature and solid tool in the armamentarium of the coronary artery disease specialist. With new areas deserving more intensified focus and several innovations ahead, it seems that OCT is there to defend its position as the standard intracoronary imaging modality for the next decennium.