Catheter Directed Therapy in Intermediate Risk Pulmonary Embolism Patients

Inclusion Criteria: * Acute pulmonary embolism patients (confirmed by CT pulmonary angiography \[CTPA\]) * symptoms started within 15 days of enrollment * intermediate-high risk pulmonary embolism patients , i.e., who have all of the following risk indicators combined :(2) i.Pulmonary Embolism Severity Index (PESI) class III-V or sPESI ≥1, ii.AND RV dysfunction on TTE or CTPA, iii.AND elevated cardiac troponin levels * with none of the following high-risk presentations: cardiac arrest, systolic blood pressure \<90 mmHg, or vasopressors required to achieve a BP ≥90 mmHg despite an adequate filling status, or end-organ hypoperfusion. Exclusion Criteria: * high risk patients who are hemodynamically unstable (cardiogenic shock, SBP \<90 mmHg, or use of intotropic support). * low risk patients with no RV dysfunction. * Patients with history of CTEPH (or previous acute PE) * Patients known to have other pulmonary hypertension, apart from group IV (CTEPH). * Patients with sever kidney injury (eGFR \<30 mg/dl/1.7m2).