Early Catheter-directed Treatment of High Risk Pulmonary Embolism

Inclusion Criteria:

1. Pulmonary embolism as confirmed by CT angiogram with high mortality risk as definedby ESC guidelines: a) One of the following: i. Cardiac arrest or ii. obstructive shock (systolic BP <90mmHg or vasopressors required to achieve a BP ≥90 mmHg despite an adequate fillingstatus), in combination with end-organ hypoperfusion (cold, clammy skin, oliguria orserum lactate ≥2 mmol/L) and b) Signs of right-ventricular dysfunction ontransthoracic echocardiogram or CT scan

2. Age ≥18 years

Exclusion Criteria:

1. Contraindications for catheter-based treatment

2. Contraindications to systemic fibrinolytic treatment or anticoagulation*

3. Active, potentially life-threatening bleeding

4. Surgery within 24h before screening

5. Cranial or spinal surgery within 14d before screening

6. Stroke within 14d before screening

7. Intracranial tumor

8. Any condition not listed here but estimated as clinically relevant as judged bythe treating investigator

9. Pregnancy

• Patients with contraindications to systemic fibrinolysis or anticoagulation canbe enrolled in a third study arm (registry) and undergo catheter-directedtherapy.