A catheter system comprising a) an elongate flexible catheter b) a lumen that extends from a proximal insertion port to a side outlet opening c) a penetrating guidewire insertable into the proximal insertion port and thereafter advanceable through the lumen and out of the side outlet opening and d) an orientation element useable to provide an indication of the trajectory on which the penetrating guidewire will advance from the catheter body. Also disclosed are methods for using such catheter to direct the penetrating guidewire out of the side opening and into the true lumen of a blood vessel when bypassing an obstruction in the blood vessel such as a chronic total occlusion (CTO) of an artery.
