systems and methods of increasing blood flow in a blood vessel with ultraluminal plaque . one disclosed method includes inserting an imaging guidewire into the blood vessel to the intraluminal plaque , propelling a catheter with a working head over the guidewire towards the distal end of the guidewire , scanning with the imaging guidewire to generate a cross - section image , radially positioning the catheter using a positioning element , monitoring the image to ascertain that the working head is properly positioned and operating the working head to remove the plaque . a computerized system designed , constructed and configured to perform the methods is further disclosed .