Purpose of the review <p>We sought to review the various intracoronary imaging modalities (intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy) and the latest evidence supporting their use in clinical practice.</p> Recent findings <p>There is an increasing body of evidence that demonstrates that imaging-guided strategies are superior to angiography alone to improve outcomes of percutaneous coronary intervention (PCI). An intriguing and promising application is use of these devices to identify and treat high-risk or vulnerable plaques. The application of these modalities in special clinical scenarios is also reviewed.</p> Summary <p>Intravascular imaging provides information beyond the angiogram that can be used to improve patient outcomes during PCI. The emerging evidence has been incorporated into the most recent practice Guideline recommendations. Future research is underway to establish the benefit of intravascular imaging for detection and treatment of vulnerable plaques.</p>