Inability to achieve vascular access is a common reason for failure to perform carotid artery angioplasty and stent placement. The authors report their experience with the use of an 8 Fr Simmons-2 catheter to gain carotid artery access in the setting of complex aortic arch anatomy. This guide catheter was used successfully to perform carotid artery angioplasty and stent placement in 10 patients with markedly tortuous aortic arches or supra-aortic branches. As the authors gained experience with this catheter, they used it as a first option in patients with the appropriate aortic arch anatomy.