The vasa vasorum are a specialized microvasculature that mainly arise from the adventitia and traverse the intimomedial layer of large arteries and veins. These are felt to serve as crucial routes of the delivery for trophic and nutritive factors, as well as regulatory signals.1 Importantly, they also play a role in pathology via proliferation in atherosclerotic and hypertrophic intimomedia, as well as plaque hemorrhage and dissection via rupture.2 In the setting of symptomatic vertebral artery stenosis, we report what is, to our knowledge, the first known in vivo visualization of the human native intracranial arterial vasa vasorum and intraplaque neovasculature using optimal coherence tomography (OCT).