Cellularity of the fibrous caps of coronary atheromas, manifested by the infiltration of macrophages (average size, 20 to 30 μm), is thought to weaken the structural integrity of the cap and predispose plaques to rupture. Therefore, an imaging technology capable of identifying macrophages within fibroatheroma caps in patients could provide valuable information for assessing plaque rupture risk. Recently, intravascular optical coherence tomography (OCT), a high-resolution coronary imaging modality, with an axial resolution of ~10 μm, has been introduced into the clinical setting. OCT images of the microstructure of the coronary artery wall enable accurate plaque-type characterization, supported by histopathological comparison data. Because of its high resolution, OCT may also be used to identify macrophages in vivo. In this paper we review recent developments in OCT for measuring macrophages in atherosclerotic plaques.