Worldwide experience in coronary catheterization and angiography for the detection and evaluation of lumen narrowing is extensive. Conventional coronary angiography analysis is complex since these arteries are of relatively small caliber and in constant movement, while being synchronized with the movement of the heart chambers and respiratory system. Moreover, atherosclerotic plaques in the coronary tree are themselves very intricate and frequently positioned in eccentric locations. The last decade has witnessed significant advances as novel data acquisition and processing techniques have been introduced. Researchers have developed novel processing systems that make it possible to construct 3D images in real-time during coronary intervention. The most common solutions are rotational imaging and reconstruction from multiple single-plane images. These techniques produce real-time 3D images of the coronary arteries in the catheterization laboratory. This article describes these state-of-the-art imaging methods and other specific novel applications in clinical practice, such as stent enhancement, guidance during transcatheter aortic valve implantation and advanced geometrical analysis with computational fluid dynamics.