Endovascular Management of Massive and Submassive Acute Pulmonary Embolism: Current Trends in Risk Stratification and Catheter-Directed Therapies

Ethan C. Kosova, Kush R. Desai, Daniel R. Schimmel*

*Corresponding author for this work

Research output: Contribution to journalReview article

3 Scopus citations


Purpose of Review: Acute pulmonary embolism (PE) is a common condition associated with high morbidity and mortality. Prior studies have evaluated the role of systemic fibrinolysis and catheter-directed therapy (CDT) in the management of PE. In this review, we examine current data on risk stratification and the appropriate allocation of systemic fibrinolysis and CDT in acute PE patients with elevated risk of adverse outcomes. Recent Findings: Classification of pulmonary embolism is based on risk of adverse events, and relies on clinical parameters, imaging findings, and biomarkers. The synthesis of this data permits appropriate risk stratification of acute PE patients, and is the foundation upon which treatment decisions are made. While systemic thrombolytics remain the frontline therapy for hemodynamically unstable PE patients, studies have suggested that CDT has a significant promise as the primary modality for treating hemodynamically stable patients at increased risk for clinical decompensation and as an alternative therapy for hemodynamically unstable patients who may not tolerate systemic thrombolytics. Summary: The appropriate use of CDT in patients with acute PE is dependent on accurate risk stratification. CDT offers the potential to reduce excessive bleeding while maintaining the efficacy of systemic thrombolytics, but will require data from larger randomized trials to support its use prior to widespread adoption as the frontline therapy for PE in patients at elevated risk of adverse outcomes.

Original languageEnglish (US)
Article number54
JournalCurrent Cardiology Reports
Issue number6
StatePublished - Jun 1 2017



  • Catheter-directed therapy
  • Pulmonary embolism
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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