Accuracy of IVOCT for measurement of neointimal thickness and effect of neointima in the appearance of metallic struts in IVOCT images was investigated. Phantom vessels were constructed and coronary stents were deployed and covered with thick (250-400 μm) and thin (30-70 μm) phantom neointima. High resolution Micro-CT images of the stent struts were recorded as a gold standard. IVOCT images of the phantom vessels were acquired with various luminal blood scattering strengths and measured neointimal thicknesses from IVOCT and Micro-CT images were compared. In transparent lumen, comparison of IVOCT and Micro-CT neointima thickness measurements found no significant difference (p > 0.05) in the thick neointima phantom but a significant difference (p < 0.05) in the thin neointima phantom. For both thick and thin neointima, IVOCT neointimal thickness measurements varied from Micro-CT values by as much as ±35%. Increased luminal scattering due to presence of blood at concentrations <5% did not interfere with measurement of thin neointimas and was validated by ANOVA analysis (p = 0.95). IV-OCT measurement of strut feature size with an overlying thin neointima match true values determined with Micro-CT (p = 0.82). Presence of a thick neointima resulted in lateral elongation or merry-go-rounding of stent strut features in IVOCT images. Phantom IVOCT images suggest that thick neointimal layers can result in more than 40 % lateral elongation of stent strut features. Simulated IVOCT images of metallic stent struts with varying neointimal thickness suggest that neointimal light scattering can introduce the merry-go-round effect.