Purpose We want to share our limited, but unique experience on the use of intravascular ultrasonography (IVUS) for the cerebrovascular intervention and discuss its feasibility and usefulness. Methods A retrospective image and medical record review was completed for the patients who underwent IVUS during various cerebrovascular intervention. Image findings with the IVUS and angiography were compared and recorded at the time of the procedure. The diameter of the vessel and the lesion, feature of the stent apposition and in-stent environment and complications were reviewed. Results Seventeen IVUS cases were enrolled for the current study. The IVUS was performed in 11 cases of stent angioplasty: 5 cases of extracranial carotid artery, 2 for orifice of vertebral artery (V1), 1 for extracranial vertebral artery (V2) and 3 intracranial arteries (V4, basilar artery and petrous ICA). And 4 diagnostic cerebral angiographies and 2 follow-up angiographies of stents were carried out with IVUS. For the carotid artery stenting (CAS), the IVUS revealed hyperacute in-stent thrombosis which was invisible on angiography because they were judged as severe and unstable stenosis on IVUS. Intracranial and vertebral artery orifice stenosis were treated with stent angioplasty safely with guidance of IVUS. It was helpful for deciding the size of the the stents and limitation of post-dilation with balloon catheters. And IVUS revealed a severe stenosis with vulnerable plaque of vertebral artery orifice which seemed to be moderate stable stenosis on diagnostic angiography. The other diagnostic IVUS findings were in the semblance of angiographic findings. Follow up IVUS for the stents showed mild in-stent restenosis. Conclusion IVUS in cerebrovascular intervention could provide valuable information about the intravascular environment which was not available on conventional angiography. This information could affect the treatment strategy or give concrete evidence for the further treatment for each lesion. Disclosures W. Yoon: None.