Abstract: An ultrasound imaging system provides coronal and transverse images for guiding a superior temporal artery guidewire (STA guidewire) through a tortuous region of the STA to an aortic arch region for snaring by a femoral artery catheter snare and pulling through for “through and through” guidewire access. The STA guidewire includes a knob at a distal end which is advanced into a superficial temporal artery (STA) using multi-plane ultrasound guidance, and the STA guidewire is guided through the tortuous region using transverse and coronal images provided by the multi-plane ultrasound imager. The transverse and coronal images indicate the rotational direction for the wire tip to advance the knob end of the STA guidewire within the STA to the external carotid artery.