A 68-year-old woman who had a stroke was found by transesophageal echocardiography to have two focal areas of pedunculated atherosclerosis in the arch of her aorta. Using echocardiographic imaging for guidance in aortic cannulation placement and deep hypothermic circulatory arrest, we removed the localized atheromata from the otherwise relatively normal aorta. She had an uneventful recovery. With the more frequent identification of discrete areas of aortic atherosclerosis as a result of transesophageal echocardiography, this procedure may become the standard by which to treat this problem.