The current study examines, at both structural and ultrastructural levels, representative segments of internal mammary arteries obtained from 15 male patients, ranging in age from 45 to 75 years, with signs or symptoms of coronary heart disease. These segments were obtained at the time of coronary bypass surgery. Of the 15 segments examined, only 2 were found to have atherosclerotic plaques. In other segments, only an intimal thickening similar to that observed during aging was found. There was evidence of endothelial cell loss and defects of internal elastic lamina in the present study; however, there was no evidence of lipid accumulation in the intimal region. This observation agrees with previous findings that indicate that lipid accumulation is not a necessary factor for the formation of atherosclerotic plaques. During the study microfilament bundles, the so-called "stress fibers," were also observed in the cytoplasm of the luminal side of endothelial cells. Stress fibers are known to be present in some endothelial cells in some pathologies such as regeneration after injury or hypertension. One of the features of the atherosclerotic plaques from an internal mammary artery was the presence of cells with contractile and synthetic phenotypes (contractile and synthetic smooth muscle cells), as well as cells with intermediate features. Cells with similar characteristics have also been observed during the development of the early stages of atherosclerosis, during embryological development of vessels, after experimental excimer laser treatment, and in primary cell culture. To our knowledge, this is the first report showing the ultrastructural features of the atherosclerotic plaques in the internal mammary artery.