Stewart LM, Spangler EL, Sutzko DC, et al. - This study was undertaken to ascertain whether there are preoperative risk factors correlated with carotid endarterectomy (CEA) requiring concomitant distal endovascular intervention (CEA+D) and evaluate outcomes compared to isolated CEA. Researchers applied the Vascular Quality Initiative CEA registry to distinguish patients undergoing CEA and CEA+D for asymptomatic or symptomatic carotid stenosis from 2013-2019. This study distinguished 327 CEA+D and compared it to105,192 isolated CEA between 2013 and 19. The power to predict CEA+D use is limited, while markers of more significant cardiovascular disease burden were correlated with the use of CEA+D. In cases where CEA+D is employed, the outcomes of this research indicated that there were associations between CEA+D, significantly higher rates of perioperative stroke and mortality in comparison with isolated CEA in both asymptomatic and symptomatic patients, which can be helpful framing expected outcomes after these methods.