Apparatus and methods are provided for delivering a guidewire, agents, and the like through an occlusion in a body vessel or other body lumen. The apparatus includes a flexible catheter or other elongate member including a proximal end, a distal end sized for insertion into a body lumen, and a first lumen extending from the proximal end to a distal region of the tubular member. An expandable sheath is provided on the distal region of the catheter that is expandable from a contracted condition to minimize a profile of the sheath to allow insertion along with the tubular member into a body lumen, to an enlarged condition wherein the sheath at least partially defines a lumen communicating with and extending distally from the first lumen of the tubular member.