Devices, systems, and methods for treating atherosclerotic lesions and other disease states, particularly for treatment of vulnerable plaques, can incorporate optical coherence tomography or other imaging techniques which allow a structure and location of an eccentric plaque to be characterized. Remodeling and/or ablative laser energy can then be selectively and automatically directed to the appropriate plaque structures, often without imposing mechanical trauma to the entire circumference of the lumen wall.
