Over the past two decades, intravascular optical coherence tomography (IVOCT) has emerged as a promising tool for planning percutaneous coronary interventions (PCI), studying coronary artery disease, and assessing treatments. With its nearhistological resolution and optical contrast, IVOCT uniquely evaluates coronary plaque characteristics, enhancing the guidance of interventional procedures. Artificial intelligence (AI) techniques have been widely applied to IVOCT imaging, providing fast and accurate automated interpretation. These techniques hold significant potential for both clinical and research purposes. Clinically, automated analysis offers comprehensive assessments of coronary plaques, leading to better treatment decisions during PCI. For research, automated interpretation of IVOCT opens new avenues to understand the pathophysiology of coronary atherosclerosis. However, these techniques face several limitations, including issues related to spatial resolution, challenges in manual assessments, and the additional time required for these analyses. This review covers recent advancements and applications of AI techniques and computational simulation methods in IVOCT image analysis, including vessel wall segmentation, plaque characterization, stent analysis, and their clinical applications. Furthermore, we discuss the potential of AI-enhanced IVOCT analysis to facilitate personalized decision-making, potentially improving short- and long-term patient outcomes.
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