Abstract: A system for treating an occlusive region of a blood vessel comprises: a catheter outer tube forming a lumen for inflation of a centering balloon; a catheter inner tube lined with either internal spiral threads or point slots to assist controlled guidewire movement; and a rotatable guidewire that may be solid or hollow. The guidewire comprises a rotatable body and a proximal shaft. The rotatable body has two components: a distal rotating head and a proximal rotating shaft, wherein these components are of equal length and the rotating shaft resides within the proximal shaft. Linear force applied to the proximal shaft will result in the rotational guidewire tip puncturing cutting through an occlusion. In an alternative embodiment, the guidewire rotatable body comprises two mechanical rings and a compression spring, wherein when the spring is released via depression of a button, the guidewire tip drills through an occlusion.