Current evidence based on recently published studies suggest image guided PCI over Angio guided PCI is associated with improved outcomes, and it is the need of the hour to all interventional cardiologists to know about intravascular imaging to maintain high standard health care practice to provide the best possible outcome to their patients. Image guided PCI is very useful in the pre PCI assessment of plaque, deciding appropriate plaque modification strategy, and sizing of balloons and stents. Post PCI optimization of DES is mainly to identifying and rectifying edge dissection, under-expansion and apposition which are associated with acute and long-term outcomes. OCT due to its high-resolution 3D images helpful in detailed assessment of vessel wall characteristics – type of plaque, plaque burden and identifying vulnerable plaque which is prone for plaque rupture, dissection, and intra & extra mural hematomas. OCT also differentiates intraluminal masses like thrombus (red & white), recanalized thrombus, CN, stent struts, position of guidewires (abluminal position, in relation to stent struts (proximal Vs distal strut crossing) and entrapped broken balloon shafts, guidewires and other intravascular foreign bodies which are very helpful in optimizing PCI results.