This talk will discuss a single institution's experience with using an off-the-shelf approach to transcarotid artery revascularization (TCAR) for managing carotid artery stenosis in high-risk surgical patients. While carotid endarterectomy (CEA) and transfemoral carotid artery stenting (tfCAS) have been effective in reducing stroke risk, tfCAS has been associated with higher periprocedural stroke rates, partly due to suboptimal embolic protection. TCAR has emerged as a safer, minimally invasive alternative that provides better embolic protection through direct carotid access and temporary flow reversal. Initial trials, such as the ROADSTER and PROOF studies, demonstrated TCAR's safety and efficacy, with lower stroke and death rates compared to both CEA and tfCAS. This presentation will highlight our institution's use of an off-the-shelf alternative to a dedicated flow reversal device, discussing procedural techniques, early patient outcomes, and the advantages of this cost-effective approach for carotid revascularization in high-risk patients.