In this episode, we explore the OCCUPI trial, a large randomized study comparing optical coherence tomography (OCT)-guided PCI to traditional angiography guidance in patients with complex coronary lesions. With over 1,600 patients enrolled, the trial showed that OCT guidance significantly reduced the rate of cardiac death, myocardial infarction, stent thrombosis, and target-vessel revascularization at one year. We discuss the trial design, key outcomes, and how these findings could shape the future of intravascular imaging in high-risk PCI cases.