Devices, methods, and systems related to imaging and ablation are disclosed. Devices methods, and systems are disclosed herein that include a local bypass, one or more first energy sources configured to function in, or proximal to, a lumen of the local bypass and to provide energy configured to elicit one or more image responses associated with the local bypass lumen; one or more sensors configured to capture the one or more image responses, control circuitry coupled to the one or more sensors, one or more second energy source responsive to the control circuitry, and configured to provide ablation energy to a target area in the local bypass lumen during the expected transit time of the one or more targets through the target area.