Disclosed are methods and devices for removing tissue from a site in a hollow organ, where the device has a low crossing profile and is capable of removing tissue at a high rate of speed. The device includes an elongate outer tube with a side opening and an inner tube moveably coaxially positioned within the outer tube. Tissue drawn into the side opening can be severed by moving the inner tube across the opening. Tissue may be removed through the device at a rate of at least about 1.4 cc per minute, through a lumen having a cross-sectional area of no greater than about 12.02 mm. Cutting may be accomplished by rotating the inner tube at a speed of at least about 4000 rpm, and axially reciprocating the inner tube at a rate of at least about 1.5 cycles per second. The window may have a rho value of no more than about 1, and the outside diameter of the device may be no more than about 3 mm.