Devices, systems, and methods to generate a bypass lumen in connection with a chronic total occlusion procedure. An exemplary method comprises introducing at least part of a first elongated body into a lumen of an artery so that a distal tip of the first elongated body is positioned on a first side of an occlusion within the lumen of the artery； inserting the distal tip of the first elongated body into a wall of the artery in between a tunica media and a tunica intima of the artery； advancing the distal tip of the first elongated body in between the tunica media and the tunica intima； and further advancing the distal tip of the first elongated body back into the lumen of the artery to generate a bypass lumen and so that the distal tip is positioned on an opposite second side of the occlusion within the lumen.
