The spread of Tantric Buddhism in the multi-cultural context of Eastern Central Asia can be traced to various textual and visual sources. The earliest evidence, probably dating from the 10th century, can be found in Tibetan manuscripts within the Dunhuang Collection. The next major transmission of Tantric materials is evident in the Tangut and Chinese manuscripts from Karakhoto, produced from the 11th century onwards, probably as a result of a strong production in the 12th century. I argue that it was only due to the imperial patronage of a series of powerful Tangut rulers (ca. 1038–1227) that the foundation was laid for the deliberate creation of an extended network of sacred sites with visual evidence of Tantric Buddhism and its ritual practices, especially in the Tibetan form. Instead of, it is from this perspective that I analyse Mogao Cave 465, the sole Tantric Buddhist cave in the Mogao cave complex, as an important Tantric sacred site, as well as in the context of the production of Tantric visual art across other sites in the Tangut Empire.