A rotational atherectomy device that includes an expandable head that can clean a blockage from vessel larger than its rest diameter, in which the drive shaft may rotate in two opposite directions and may have different abrasive characteristics for each rotation direction. In one direction, the head may be configured for cutting and/or slicing, which may be well suited to removing particularly soft blockage material. In the other direction, the head may be configured for grinding, scraping and/or sanding, which may be well suited to removing particularly hard blockage material. The head includes one or more arms that are pivotally or hingedly attached to the drive shaft. One or more abrasive elements are disposed on or are attached to the one or more arms. The abrasive elements have a cutting feature, such as a sharpened edge that cuts like a razor blade when the drive shaft is rotated in the "cutting" direction. The abrasive elements also have a grinding feature, such as an abrasive material disposed on the abrasive element adjacent to the sharpened edge, which grinds away a blockage when the drive shaft is rotated in the "grinding" direction.
