Coronary angioscopy will not replace angiography as the gold standard for imaging atherosclerotic coronary arteries. However, there may well be a clinical niche for a technology that gives accurate information regarding a specific lesion, if that information can be used to improve the acute or chronic outcome of an interventional procedure. Our experience demonstrates that angioscopy indeed provides this information. Using angioscopy, we now have access to information regarding arterial wall disease that heretofore has been available only at necropsy. In addition, whereas angiography has provided only a 2-dimensional, gray-scale image of the coronary vessels, angioscopy offers a full-color, 3-dimensional perspective of the intracoronary surface morphology. These important lesion-specific details, not reliably available from angiography alone, may ultimately be used to improve patient outcome and to assess risk.