Early Catheter-directed Treatment of High Risk Pulmonary Embolism

Inclusion criteria

• Pulmonary embolism as confirmed by CT angiogram with high mortality risk as defined by ESC guidelines:

a) One of the following: i. Cardiac arrest or ii. obstructive shock (systolic BP <90 mmHg or vasopressors required to achieve a BP ≥90 mmHg despite an adequate filling status), in combination with end-organ hypoperfusion (cold, clammy skin, oliguria or serum lactate ≥2 mmol/L) and b) Signs of right-ventricular dysfunction on transthoracic echocardiogram or CT scan

• Age ≥18 years

Exclusion criteria

• Contraindications for catheter-based treatment
• Contraindications to systemic fibrinolytic treatment or anticoagulation*

• Active, potentially life-threatening bleeding
• Surgery within 24h before screening
• Cranial or spinal surgery within 14d before screening
• Stroke within 14d before screening
• Intracranial tumor
• Any condition not listed here but estimated as clinically relevant as judged by the treating investigator
• Pregnancy

• Patients with contraindications to systemic fibrinolysis or anticoagulation can be enrolled in a third study arm (registry) and undergo catheter-directed therapy.