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Pulmonary embolism (PE) represents a major cause of cardiovascular morbidity and mortality.
Over the last few years, there has been an increase in the incidence of PE, while
simultaneously the mortality rates associated with PE have been declining. The improved
survival rates in PE are likely to result from the better availability of more precise diagnostic
methods, better adherence to guidelines and the use of new enhanced therapeutic
options. Since hemodynamic compromise is the principal cause of poor outcome in
patients with acute PE, early identification of patients at risk and appropriate risk stratification
of patients with PE are essential for further management and can direct the use
of more invasive treatment strategies. Anticoagulation therapy is the cornerstone of treatment
for acute PE, while for hemodynamically unstable patients, systemic thrombolysis
is the recommended treatment of choice. However, systemic thrombolysis comes with
a cost of increased risk for major bleeding, including possibly fatal intracranial bleeding.
Interventional catheter-based therapies with mechanical thrombectomy or catheter-
-directed thrombolysis with very low doses of thrombolytic offer the possibility for this
bleeding risk to be minimized, while sufficient recanalization of pulmonary arteries allows
for hemodynamic stabilization and improves the patient’s symptoms. The decision when
to use interventional procedures over pharmacological treatment is still a matter of debate,
especially in the intermediate-high-risk group of PE patients. Ongoing studies comparing
one interventional method against another, and catheter-based therapies against anticoagulation
are ongoing. While the results of these studies are eagerly awaited, implementations
of local hospital protocols for optimal PE treatment with consultations between
multidisciplinary specialists in the so-called PE response team are suggested.