OCT is an imaging technique with high resolution and plays a key role in diagnosis and management of stent thrombosis (ST). It must be noted that all stent thrombosis are not equal. It is important to identify the specific cause of stent thrombosis. The cause may vary depending on the time course - subacute, late and very late. Identification of specific causes of stent thrombosis can help make the strategy specific to the cause and can prevent recurrent stent thrombosis. Intravascular OCT may provide insights into mechanistic processes leading to ST. The PRESTIGE Consortium (Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort) subjected patients presenting with ST to OCT imaging of the culprit vessel with frequency domain OCT. In patients with ST, uncovered and malapposed struts were observed with the incidence of both decreasing with longer time intervals between stent implantation and presentation. The most frequent dominant observation varied according to time intervals from index stenting: uncovered struts and underexpansion in acute/subacute ST and neoatherosclerosis and uncovered struts in late/very late ST.