Optical coherence tomography (OCT) utilizes near infrared light with a wavelength of 1.30 μm and is generated from a rotating fibre-optic system.When compared to intravascular ultrasound (IVUS), the shorter wavelength of OCT (1.3 μm) confers excellent axial resolution but at the cost of lower depth penetration (1-2 mm vs. 5-6 mm). Red blood cells have a strong tendency to absorb and scatter light, which attenuates the image. Therefore, when assessing coronary arteries with OCT, it is important to clear blood from the field of examination and this is usually done with a contrast agent. This makes it prone to artefacts from residual blood, and limits its use in patients with advanced chronic kidney disease, ectatic vasculature and aorto-ostial lesions where IVUS tends to be preferred. However, OCT outperforms IVUS in the assessment of calcific lesions, identification of high-risk plaque features, and studying the mechanism of stent failure. In this article, we provide an up-todate review of the technology behind OCT, its limitations, and how the two intracoronary imaging modalities compare in various clinical scenarios.