INTRODUCTION: Carotid bifurcation intervention (CBI) remains controversial and highly scrutinised (ref 1). The Crest 2 trial arguably helps guide treatment of asymptomatic high-grade stenotic disease. CBI in Australia and NZ has been CEA or TFCAS. The ENROUTE reverse-flow TCAR System introduced into Australia in March 2026 allows an additional method. METHODS: CEA commenced 20/2/86 evolving from GA / obligatory shunting through LA / selective shunting (LASS)/ vein patching through LASS / eversion CEA (LASSeCEA). TFCAS commenced 2/9/05 evolving to primary carotid stenting (PCS) avoiding a balloon. TCAR commenced 3/3/26 (choosing only high-grade asymptomatic stenoses). RESULTS: 2792 CBI (to 20/6/26). CEA: 2250; TFCAS: 531; TCAR: 11. LASSeCEA DWI rate of 3% is the lowest recorded and in the largest series published (ref 2). PCS: zero CVA/death (CD). TCAR: 10GA;1LA; zero CD. 5 TCAR stayed more than 1 night {2 persistent hypotension, 1 persistent bradycardia (BC), 1 random BC, 1 social reason}. CEA: 76% and TFCAS: 84% overnight, OPINIONS/CONCLUSIONS: TCAR is a safe, valuable addition for CBI. In our practice it will expand options, particularly for high carotid bifurcations. For high grade lesions stenting has a significantly increased rate of haemodynamic compromise compared to CEA.TCAR had a shallow learning curve for us. It will be steeper for those without stent experience but not as steep as TFCAS. It should be embraced by the ANZSVS to increase our “skin in the stent game”. In our practice CEA remains the gold standard for symptomatic patients but TCAR will challenge this with time. 1.Bourke BM. Intervention on the carotid bifurcation—75 years on, still not nailed. Editorial ANZ Journal of Surgery. 2025 Oct;95(10):1979 -1981 2.Bourke VC, Bourke BM, Beiles CB. Operative factors associated with the development of new brain lesions during awake carotid endarterectomy. European Journal of Vascular and Endovascular Surgery. 2016; 51:167–173.