TOTAL VASCULAR OCCLUSION TREATMENT SYSTEM AND METHOD

A system is provided for providing vascular access across chronic total occlusions, in particular those that are particularly long such as in the lower periphery. A guide wire has an off-set, tilted tip section that provides rotational micro-dissection through tight CTO lesions. An outer catheter sheath prevents binding of the wire via wire reinforced composite polymeric construction. The outer sheath catheter includes an ablative outer surface for ablating tissue in contact therewith. The guide wire and outer sheath catheter are each driven by an actuator for cooperative advancement through the CTO. Rotational couplers rotate them, which may be at different speeds and via different couplers. The engagement of the wire within the sheath may allow for at least limited longitudinal movement between them during CTO advancement. Aspiration of ablated debris around the outer rotational ablation catheter is accomplished through suction ports through the composite wall and between adjacent windings of the reinforcement. Long CTOs of the peripheral vasculature are in particular benefited by the assembly, which allows on-going force transmission to the distal components through long portions of blockage, and allows for pilot lumen formation for advancing other interventional tools.