Optical coherence tomography (OCT) is a tissue imaging based on infrared ray, and it can achieve a resolution up to 10-20 μm. It has been widely used in the diagnosis and treatment of coronary artery diseases, and its applications in the diagnosis and treatment of cerebrovascular diseases have also been increasingly valued. The applications of OCT in interventional diagnosis and treatment of carotid artery stenosis, intracranial artery stenosis and dissection, cerebral aneurysms and cerebral venous diseases have made some progress, but there is still a lack of robust large-sample evidence. Due to the unique anatomical features of cerebral vessels, there is a need for more suitable instrument designs. With the continuous improvement in instrument designs and techniques, OCT is expected to become a crucial imaging tool for the prevention, diagnosis, and treatment of cerebrovascular diseases.