A material removal device (2, 2B, 2C, 2D) for cutting material from the lumen of a vessel comprising: a tubular sheath having distal and proximal ends and a lumen; a first drive shaft (3, 3a, 3b) extending through the lumen of the tubular sheath, the first drive shaft (3, 3a, 3b) being configured to rotate in a first direction; a second drive shaft (6a, 6b, 6c, 6d) extending through the lumen of the tubular sheath, the second drive shaft being configured to rotate in a second direction; a distal cutting element coupled to the first drive shaft (3, 3a, 3b) and configured to cut tissue, wherein the distal cutting element has a surface, a distal cutting edge positioned at a radially outer circumferential edge of the distal cutting element, and first flutes extending longitudinally along the distal cutting element, wherein the surface directs the tissue cut by the distal cutting edge proximally through the first flutes; a tissue borer at the distal end of the second drive shaft (6a, 6b, 6c, 6d) and configured to bore through tissue, wherein the tissue borer is received in the distal cutting element, the tissue borer having a distal portion formed with a helical cutting surface, and borer flutes extending longitudinally along the tissue borer from a proximal portion through the distal portion to allow cut tissue to pass proximally therethrough, wherein the borer flutes of the tissue borer function in combination with the first flutes of the distal cutting element to break down tissue cut by the distal cutting element and the tissue borer; and a driver (10, 11) coupled to the first and second drive shafts (3, 3a, 3b, 6) and configured to rotate the first drive shaft (3, 3a, 3b) in the first direction and the second drive shaft (6a, 6b, 6c, 6d) in the second direction, wherein the distal cutting element and the tissue borer have a first state for delivery or removal of the material removal device (2, 2B, 2C, 2D) in which the distal cutting element and the tissue borer are contained within the lumen of the tubular sheath and a second state in which the distal cutting element and the tissue borer are at least partially exposed beyond the distal end of the tubular sheath. a tubular sheath having distal and proximal ends and a lumen; a first drive shaft (3, 3a, 3b) extending through the lumen of the tubular sheath, the first drive shaft (3, 3a, 3b) being configured to rotate in a first direction; a second drive shaft (6a, 6b, 6c, 6d) extending through the lumen of the tubular sheath, the second drive shaft being configured to rotate in a second direction; a distal cutting element coupled to the first drive shaft (3, 3a, 3b) and configured to cut tissue, wherein the distal cutting element has a surface, a distal cutting edge positioned at a radially outer circumferential edge of the distal cutting element, and first flutes extending longitudinally along the distal cutting element, wherein the surface directs the tissue cut by the distal cutting edge proximally through the first flutes; a tissue borer at the distal end of the second drive shaft (6a, 6b, 6c, 6d) and configured to bore through tissue, wherein the tissue borer is received in the distal cutting element, the tissue borer having a distal portion formed with a helical cutting surface, and borer flutes extending longitudinally along the tissue borer from a proximal portion through the distal portion to allow cut tissue to pass proximally therethrough, wherein the borer flutes of the tissue borer function in combination with the first flutes of the distal cutting element to break down tissue cut by the distal cutting element and the tissue borer; and a driver (10, 11) coupled to the first and second drive shafts (3, 3a, 3b, 6) and configured to rotate the first drive shaft (3, 3a, 3b) in the first direction and the second drive shaft (6a, 6b, 6c, 6d) in the second direction, wherein the distal cutting element and the tissue borer have a first state for delivery or removal of the material removal device (2, 2B, 2C, 2D) in which the distal cutting element and the tissue borer are contained within the lumen of the tubular sheath and a second state in which the distal cutting element and the tissue borer are at least partially exposed beyond the distal end of the tubular sheath.