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.