Among patients with carotid artery stenosis, carotid endarterectomy is the established treatment standard for carotid revascularization, although transfemoral carotid artery stenting has been used as an alternative technique for patients at high surgical risk for endarterectomy. Several studies have shown that transfemoral carotid artery stenting has a higher periprocedural stroke risk compared with carotid endarterectomy, particularly in patients who are symptomatic and elderly.^1-4 Quiz Ref ID In 2015, transcarotid artery revascularization, with a specially designed transcarotid flow reversal neuroprotection system, was developed as a new technique for carotid stenting. In contrast with the transfemoral approach, transcarotid artery revascularization avoids catheter manipulation in the aortic arch by direct carotid access and initiates cerebral protection through an extracorporeal arteriovenous shunt from the carotid artery to femoral vein prior to manipulating the target lesion.