Purpose of Review The purpose of this paper is to review the history of intracoronary imaging as it pertains to the development of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) devices. Recent Findings Coronary angiography continues to maintain its stronghold as the diagnostic modality of choice in the diagnosis of coronary artery disease. Limitations in scope, however, have necessitated the development of adjunctive forms of imaging through IVUS and OCT in order to augment the comprehensive assessment and therapeutic management of angiographic findings. Summary IVUS and OCT have significantly enhanced current day percutaneous coronary intervention. Over the last 30 years, advancements in their design and technology have solidified a framework for clinical decision-making in the cardiac catheterization lab and have helped more accurately assess and treat coronary artery disease.