Choosing the myocardial revascularization method for elderly and oldest age patients still remains quite a serious problem these days. Extremely high risk of open surgery often makes percutaneous coronary intervention (PCI) the only possible method to solve this problem. Severe comorbidity, coronary peculiarities, high risk of postoperative hemorrhages and also financial aspects related to the need of taking long-term double antiplatelet therapy, require clear decision about intervention and choice of optimal revascularization tactics. For oldest age group patients with vascular and plague structure different from young ones, with severe calcification dominance, with reducing fibrous constituent, with big necrotic core and frequent high-risk fibroatheromas, intravascular ultrasound (IVUS) plays a tremendous role in choosing the tactics and control of PCI results.