An intravascular ultrasound catheter having an imaging array and ablation electrodes is provided. The imaging array and ablation electrodes are forward facing and the catheter can be used to ablate plaque in partially or totally occluded blood vessels under real time ultrasound visualization. The ablation electrodes are integrated into the distal face of the catheter and allow ultrasound to pass through them, which provides the ability to achieve highly accurate real time visualization of the tissue undergoing treatment.