Abstract: Recanalization apparatus for use in crossing a stenosis forming a total occlusion in a vessel formed by a vessel wall, the stenosis having a distal end cap which is convex facing in a proximal direction. The apparatus is comprised of an outer sheath formed of an elongate flexible tubular member having proximal and distal extremities and having a lumen extending from the proximal extremity to the distal extremity. An inner sheath is slidably mounted in the lumen of the outer sheath and is formed of a flexible elongate tubular member having proximal and distal extremities. The distal extremity has a sharpened tip. The inner sheath has a length so that when the sharpened tip is disposed distally of the distal extremity of the outer sheath, the proximal extremity extends proximally of the proximal extremity of the outer sheath. An imaging guide wire is slidably mounted in the lumen of the inner sheath and has proximal and distal extremities.

Abstract: Recanalization apparatus for crossing a stenosis forming a total occlusion in a lumen in a vessel formed by a vessel wall. The stenosis has a fibrous cap comprising a guiding sheath comprised of a flexible elongate tubular member having proximal and distal extremities. A lumen extends from the proximal extremity to the distal extremity. A hemostasis valve is mounted on the proximal extremity of the flexible elongate tubular member. A needle cannula is slidably mounted in the lumen of the guiding sheath and has proximal and distal extremities and has a lumen extending from the proximal extremity to the distal extremity. A sharpened tip is mounted on the distal extremity. The needle cannula has a length so that its proximal extremity extends beyond the proximal extremity of the guiding sheath when the sharpened tip is deployed beyond the distal extremity of the guiding sheath.