Abstract
Pulmonary embolism (PE) is the third major cause of cardiovascular death in western countries. High-risk PE, defined by haemodynamic instability, necessitates immediate reperfusion therapy. Intermediate-high-risk patients, although stable, are vulnerable to rapid deterioration and therefore require intensive monitoring. To accurately stratify these patients, predict mortality and identify those who may benefit from more aggressive therapies, it is essential to consider various clinical and imaging parameters. Catheter-directed therapy (CDT) has been shown to reduce clot burden and right ventricle overload with fewer bleeding complications than systemic thrombolysis. CDT's clinical utility in the management of PE continues to expand, guided by the expertise of pulmonary embolism response teams, ensuring a multidisciplinary approach tailored to each patient's risk and clinical profile. As PE management advances, ongoing research and large-scale trials are essential for validating CDT's role in reducing morbidity and mortality in intermediate-high-risk PE cases. This review aims to provide a more in-depth perspective on intermediate-high-risk PE.