Catheter-Directed Pulmonary Reperfusion in Treatment of Pulmonary Embolism Patients

Inclusion Criteria: * Age \>18 years old. * Both gender males and females. * Patients with angiographically confirmed acute high risk pulmonary embolism with shock index \>1. * pulmonary arterial occlusion with \>50% involvement of the central (main and/or lobar) pulmonary, and dysfunction of the right ventricle and elevated troponin. * patients with high risk pulmonary embolism who remain unstable after receiving fibrinolysis * patients with high risk PE pulmonary embolism who cannot receive fibrinolysis * patients with intermediate high risk PE pulmonary embolism with adverse prognosis (new hemodynamic instability, worsening respiratory failure, severe RV (right ventricle) dysfunction, or major myocardial necrosis) Exclusion Criteria: * patients with echocardiographically confirmed right sided thrombi. * patients with low-risk PE pulmonary embolism or submassive acute PE pulmonary embolism with minor RV (right ventricle) dysfunction, minor myocardial necrosis, and no clinical worsening * Anaphylactic reaction to contrast media. * Acute renal failure or severe chronic non-dialysis dependent kidney disease. * Uncooperative patient