Left carotid artery access via right radial approach is facilitated by presence of “bovine arch” variant.  Classic aortic arches are more challenging when it comes to bringing up devices like Pipeline over the siphon because of tendency of access system to herniate into the arch and descending aorta, but still possible with the right tools.  In this case, we used a larger, 7F radial glidesheath, with a tri-axial system of 5F shuttle, 058 Navien, and 027 Phenom.  It is a quite stable platform.  Video montage courtesy of Dr. Omar Tanweer, NYU Neurosurgery