Image processing based optimal catheter selection is a newly developed approach for coronary artery angiography. In image processing based approach, an optimal catheter is selected (before intervention) on the basis of internal anatomy of the patient’s coronary artery. This advanced method of optimal catheter selection provides extremely valuable information on coronary artery structures, and reduces the operating time and risks of testing different catheters on a patient. The aim of this paper is to describe and evaluate image processing based optimal catheter selection in coronary angiography. This paper also presents the main limitations of image processing based optimal catheter selection approach, and provides possible solutions and suggestions for future research.