The techniques and tools for percutaneous removal of transvenous leads have undergone substantial development over the past several decades. Although the use of locking stylets and powered sheaths to free leads from encapsulated scar tissue has improved the success rate, the procedure still carries a significant risk of morbidity and mortality even in the hands of experienced operators. The threshold for lead extraction continues to evolve. The initial use of the procedure was limited to patients with life-threatening infections because of limited tools, lower success rates and high complication rates.