Background: Transcarotid artery revascularisation (TCAR) is a hybrid technique that reduces embolic risk by avoiding aortic arch manipulation and using direct carotid access with flow reversal cerebral protection. For the Vascular Surgeon it may offer a shorter learning curve than transfemoral carotid artery stenting (TF-CAS), with outcomes comparable to carotid endarterectomy (CEA) in selected patients. Methods: We report the introduction of a TCAR service within an Australian health service, focusing on proctoring, regulatory approval, and governance, contextualised by prior institutional outcomes with CEA and TF-CAS. Critical technical and pharmacological steps are outlined. Implementation aligned with Australian requirements for new interventional procedures. Author experience includes TF-CAS (n=270), TCAR (n=11; 5 primary operator), and CEA under local anaesthesia (n=173). Results: Eleven patients underwent TCAR (7 male), aged 62–91 years (mean 76). Comorbidities included ischaemic heart disease (n=7), diabetes (n=4), hypertension (n=7), and smoking (n=9). All lesions were asymptomatic high-grade stenoses (80–99%); 7 had St Mary’s ratio >30. Technical success was 100%. All cases required pre-dilation; 5 required post-dilation. Ten stents were tapered and 40 mm in length. There were no perioperative strokes, deaths, or myocardial infarctions. Six patients were discharged the next day; five had delayed discharge due to hypotension (n=2), bradycardia (n=2), or social factors (n=1), requiring selective ICU and cardiology input. Conclusions: TCAR can be safely introduced by the Vascular Surgeon with appropriate proctoring, multidisciplinary planning, prior carotid experience, structured haemodynamic monitoring, and clear escalation pathways. Contemporary data support low stroke and mortality rates, and TCAR may play an increasing role in asymptomatic high-grade disease as trials such as CREST-2 further define revascularisation.