Lead dwell time (DT) is associated with increased complexity of cardiac implantable electronic device (CIED) extraction. Optimal strategies for risk mitigation are not well studied. Evaluate the role of intravascular lithotripsy (IVL) in extraction of leads with DT ≥10 years. We conducted a retrospective cohort study of adult patients who underwent CIED extraction since 2020 with at least one lead with DT ≥10 years. Primary outcomes were the number of tools used for each patient, clinical success, and fluoroscopy time. Secondary outcomes included laser application time, major complications, and post-procedure lead function outcomes for retained functional leads. There were 33 IVL and 91 control patients in the cohort. There was no significant difference in locking stylet, laser sheath, and mechanical sheath use. Fluoroscopy time was significantly longer in the patients receiving IVL compared to conventional extraction patients (Control: median 26.7 min [16.3 min, 44.4 min], n=91 vs IVL: median 39.3 [33.1 min, 53.7 min], n=33; p = 0.002). Two patients who received IVL and three control patients had major complications; all had lead-related significant venous occlusion. Five patients who underwent IVL retained functional leads, which demonstrated stable function post-procedure at a median follow up of 1.25 years [1.24 years, 1.44 years]. IVL did not improve procedural efficiency or complexity in our cohort. Partial venous occlusion may represent a risk factor for cardiovascular injury. Further studies of specific patient cohorts, such as those with imaging-proven, lead-associated calcified adhesions, may help define benefit of IVL in CIED extraction.