Contrast arteriography is currently the principal method for assessment of the presence and severity of both peripheral and coronary vascular anatomy. With the rapid progress in interventional radiology and cardiology, there is an increasing need for more specific information on vascular pathology and better understanding of its pathophysiology. Noninvasive ultrasound imaging may allow cross-sectional visualization of certain but limited portions of the peripheral arterial system [1, 2] but has serious limitations for imaging the coronary arteries [3,4]. The intraoperative epicoronary application of highfrequency transducers has confirmed the abnormal findings of earlier pathologic studies and further corroborated the insensitivity of coronary arteriography in appraising the extent and distribution of atherosclerotic wall disease [5]. Fiberoptic angioscopy allows visualization of the inner surface of the arterial wall and has significantly added to our understanding of acute ischemic syndromes. The method, however, has practical limitations and no information on the vessel wall under the endothelium is obtained [6].Clearly, there is a need for an imaging method allowing the study of the vessel wall and both the characterization and quantification of its pathology. Ultrasonic real-time intravascular echography allows cross-sectional i.e. circumferential imaging providing information on the arterial wall under the endothelial surface [7]. This technique has unique and fundamental advantages over presently available techniques. In this contribution we will describe the principles of intravascular real-time, two-dimensional echocardiography and give a perspective of the potential applications of this exciting new method.