The Vision-FFR trial is set to compare visual fractional flow reserve (vFFR) using angiography-derived techniques against optical coherence tomography (OCT)-based assessment in patients with chronic coronary syndromes. The study targets a long-standing clinical problem: intermediate lesions are difficult to classify as functionally significant using angiography alone. If vFFR can reliably align with OCT-derived measures of physiology, it could support broader adoption of less invasive decision pathways in catheterization labs. The trial’s head-to-head structure emphasizes whether imaging-derived functional inference can match more detailed intravascular visualization. For interventional cardiology workflows, the outcome could shape how clinicians triage stenoses and decide between medical management and revascularization.