The coronary adventitia harbours the vasa vasorum (VV), which has a diameter of 50–300 μm and plays an important role as a network of nutrient blood vessels to the arterial wall. The VV is thought to be involved in the development of coronary atherosclerosis. Recent advances in the field of intracoronary imaging, including optical coherence tomography, have enabled us to visualise coronary VV in humans in vivo and increased the clinical relevance of the VV in patients with coronary artery disease.