Optical coherence tomography (OCT) has become a key technique in the diagnosis of coronary artery stenosis, which can identify plaques and vulnerable plaques in the image. Therefore, this technique is of great significance for the diagnosis of coronary heart disease. However, there is still a lack of automatic, multi-region, high-precision segmentation algorithms for coronary OCT images in the current research field. Therefore, this paper proposes a multi-zone, fully automated segmentation algorithm for coronary OCT images based on neutrosophic theory, which achieves high-precision segmentation of fibrous plaques and lipid regions. In this paper, the method of transforming OCT images into T in the area of neutrosophics is redefined based on the membership function, and the segmentation accuracy of fiber plaques is improved. For the segmentation of lipid regions, the algorithm adds homomorphic filter enhancement images, and uses OCT to transform OCT images into I in the field of neutrosophics, and further uses morphological methods to achieve high-precision segmentation. In this paper, 40 OCT images from 9 patients with typical plaques were analyzed and compared with the results of manual segmentation by doctors. Experiments show that the proposed algorithm avoids the over-segmentation and under-segmentation problems of the traditional neutrosophic theory method, and accurately segment the patch area. Therefore, the work of this paper can effectively improve the accuracy of segmentation of plaque for doctors, and assist clinicians in the diagnosis and treatment of coronary heart disease.