Devices and methods for percutaneous translumenal minimally invasive coronary surgery, particularly bypass surgery involving the following basic steps: determining a proper location for treatment, navigating a suitable device to the treatment site, creating an extravascular opening and pathway, guiding and/or monitoring the progress of creating the opening and pathway, and maintaining the extravascular opening and pathway. One or more extravascular openings and/or pathways may be created to define a fluid path or bypass around the vascular restriction. For example, an intravascular catheter for creating an extravascular opening in a vessel wall includes an elongate shaft adapted for intravascular navigation, an anchoring mechanism disposed on the distal end of the shaft, and a tissue penetrating member having a proximal end slidably disposed in the shaft and a distal end including a tissue penetrating mechanism.