Purpose: Severe carotid artery calcification is a technical challenge during carotid revascularization and has been associated with suboptimal stent expansion and residual stenosis. Intravascular lithotripsy (IVL) has emerged as an adjunct for plaque modification; however, clinical experience in conjunction with transcarotid artery revascularization (TCAR) is limited. This study evaluated the safety and perioperative outcomes of IVL-assisted TCAR compared with TCAR alone. Methodology: A retrospective review was performed of patients undergoing TCAR at two affiliated hospitals between 2018 and 2024. Baseline demographics, comorbidities, procedural characteristics, and 30-day postoperative outcomes were analyzed. Patients undergoing IVL-assisted TCAR were compared with those undergoing standard TCAR. Results: Among 723 patients undergoing TCAR, 19 (2.6%) underwent adjunctive IVL. Patients treated with IVL were older than those undergoing standard TCAR (median age 78 vs 73 years; p=0.036). Baseline comorbidities, symptom status, medication use, and degree of stenosis were similar between groups. IVL-assisted procedures required longer operative times (84 vs 70 minutes; p=0.006) but no increase in length of stay. No strokes, myocardial infarctions, deaths, cranial nerve injuries, reoperations, or other major perioperative complications occurred in the IVL cohort, compared with stroke, myocardial infarction, and mortality rates of 1.7%, 0.4%, and 0.1%, respectively, in the standard TCAR group. Conclusion: IVL during TCAR appears safe and feasible for the treatment of heavily calcified carotid lesions, achieving perioperative outcomes comparable to standard TCAR despite treatment of an older patient population. These findings support IVL as a useful strategy in selected patients with severe carotid calcification. Future studies incorporating CT imaging based calcium burden scoring and propensity-matched comparisons with carotid endarterectomy are underway.