Purpose Transcarotid artery revascularisation (TCAR) is an emerging alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS), utilising direct carotid access with dynamic flow reversal neuroprotection. We describe establishment of a TCAR program at a single centre through development of a protocol-driven “TCAR Patient Journey” and report early clinical outcomes. Methodology A multidisciplinary “TCAR Patient Journey” was developed using TCAR trial data and contemporary carotid revascularisation guidelines. The pathway standardised the TCAR patient journey, encompassing pre-operative assessment and optimisation, intra-operative flow reversal and haemodynamic management, and post-operative monitoring and mobilisation. Program implementation included multidisciplinary engagement with on-site proctorship during initial cases. Prospective perioperative and outcome data were collected for all TCAR procedures performed during program establishment. Results Eight TCAR procedures were performed during the initial rollout period (six asymptomatic; two symptomatic). Technical success was achieved in all cases. Mean procedure time was 102.8 minutes (range 84–124). There were no peri-procedural or 30-day strokes, myocardial infarctions, deaths, cranial nerve injuries, or returns to theatre. Postoperative haemodynamic instability occurred in five patients, including four episodes of hypotension managed with protocolised metaraminol and midodrine therapy and one episode of hypertension managed with labetalol. All resolved without neurological sequelae. Median ICU length of stay was 1 day (range 1–2). Conclusion TCAR can be safely implemented through structured proctorship and standardised perioperative protocols. Standardised pathways facilitated safe early adoption and multidisciplinary coordination. This framework may provide a reproducible model for centres establishing TCAR programs without existing pathways.