One of the important goals in the surgical treatment of diseases of the cardiovascular system is to minimize complications. The most dangerous complication is perioperative acute cerebrovascular accident and encephalopathy. The risk of their occurrence increases significantly without careful preoperative and intraoperative assessment. A preoperative computed tomography (CT) scan is the gold standard to rule out aortic calcification. However, CT data are not sufficient for complete visualization of atheromatous changes. Intraoperative ultrasound epiaortic scanning (EpiUS) allows to identify with high accuracy the presence or absence of atheromatous changes in the ascending part and arch of the aorta. At the same time, the use of EU has not become widespread. The article presents 3 clinical cases demonstrating the use of preoperative CT and intraoperative EU in patients undergoing coronary artery bypass grafting. Based on these imaging techniques, the surgical tactics during the operation were changed: changing the cannulation site, using the «Single clamp» technique and operating on a beating heart. Preoperative CT and intraoperative EU together make it possible to choose the correct surgical treatment tactics and thereby reduce the risk of complications. © 2025 Tomsk State University. All rights reserved.