The objective of this video is to demonstrate the new technology and techniques available for revascularization of carotid stenosis. The transcarotid arterial revascularization (TCAR) procedure is a new technique that utilizes reversal of blood flow in the operative carotid artery as a neuroprotection strategy to prevent arterial emboli during the procedure. In addition, it is a new technique for carotid artery stenting as arterial access is gained directly through the carotid artery. The video details the procedure as a composite of multiple cases to emphasize the areas of particular significance in regard to the new technique. This video is designed to explain the purpose of the TCAR procedure and what role it plays in treating carotid stenosis. The beginning of the video goes through slides to educate the surgeon about the background and concept of the TCAR procedure. The second objective is to detail the skin-to-skin operative procedure. It highlights the set up and use of the neuroprotective device as well as inserts fluoroscopy images in real time. This video creates a strong educational format to allow surgeons to understand the concepts and techniques associated with this procedure. Finally, we use novel data to demonstrate the safety and efficacy of the procedure.