A device for creating a
pilot hole through lesions in body passageways including an elongated flexible
drive shaft advanceable over a guide wire, the
drive shaft having a proximal end and a distal end, and a piloting head fixedly attached to at least a portion of the distal end of the driveshaft, wherein the piloting head comprises a distal end having a first
diameter, a proximal end having a second
diameter that is larger than the first
diameter, and an intermediate shoulder area comprising a third diameter that is larger than the first and second diameters, wherein the intermediate shoulder area comprises a radiused crest having a backside area having an
abrasive coating, and wherein the diameter of the piloting head tapers down at a generally
constant angle from the intermediate shoulder area to the proximal end of the piloting head.