PURPOSE Transcervical Carotid Artery Revascularization (TCAR) combines the benefits of endovascular carotid stenting with cerebral protection through flow reversal, offering an alternative to conventional carotid endarterectomy (CEA) and to transfemoral carotid artery stenting (TF-CAS). Current TCAR protocols rely on a dedicated flow reversal device which carries considerable costs. This study aimed to demonstrate the feasibility and safety of TCAR performed with an off-the-shelf setup as an option for treatment of carotid disease. METHODOLOGY This prospective, open-label, multi-center study consecutively enrolled patients requiring carotid revascularization for internal carotid artery disease from July 2023 onwards. All procedures were performed under general anesthesia using an off-the-shelf flow reversal circuit comprising a standard 8 Fr sheath in the common carotid artery (CCA) and an 11 Fr sheath in the common femoral vein (CFV), connected by a wide-bore extension tube. No proprietary flow reversal or neuroprotection device was used. The primary endpoint was procedural success at 30 days (stent patent and without cerebrovascular accident, myocardial infarction, or death). RESULTS 26 patients were included, with a median age of 73 and 42% (11/26) having both anatomical and physiological high-risk factors. 73% (19/26) of the cohort had symptomatic disease. Median procedural time was 1h:21m, median flow reversal time 10m:48s. Procedural success was achieved in 96%. Material cost of the off-the-shelf setup (including stent) was 1,741 AUD, compared to 10,010 AUD for the dedicated flow-reversal device setup. CONCLUSION Off-the-shelf TCAR is technically feasible and appears safe, with 96% 30-days procedural success. The setup offers a dramatic cost reduction compared to dedicated flow-reversal device, and if confirmed in larger studies could offer a viable and cost-effective alternative to conventional CEA and TF-CAS.