Methods and systems for re-entering the true lumen of a vessel after subintimally bypassing an occlusion in a blood vessel. A guidewire is positionable within a subintimal tract in a wall of the blood vessel with a distal end located beyond the occlusion. A hollow lumen of the guidewire includes a retractable blade slidably exposable adjacent a distal end thereof for rotary cutting or scoring the intima layer of the vessel wall to create a transverse cut or line of weakness in the intima. A balloon catheter is subsequently trackable over the guidewire and once inflated tears or otherwise ruptures the transverse cut, thereby creating or enlarging a passageway into the true lumen of the blood vessel beyond the occlusion.
