Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy

Inclusion Criteria:

1. Symptomatic PE diagnosed by contrast-enhanced CT angiography with involvement of amain or lobar pulmonary artery branch; and

2. Right ventricular (RV) dilation as defined by the presence of an RV/Left ventricularratio > 1 on CT angiography

Exclusion Criteria:

1. Age < 18 years

2. Systolic blood pressure < 90 mmHg for >15 consecutive minutes or > 40 mmHg drop frombaseline, or vasopressor requirement for blood pressure support (i.e., massive PE),occurring within 1 hour prior to eligibility assessment.

3. Symptom duration > 14 days for the current PE episode

4. Irreversible INR > 3

5. Irreversible Thrombocytopenia (Platelets < 50,000/microliter)

6. Creatinine > 2.0 mg/dl

7. Hemoglobin < 7.0 g/dl

8. Pregnancy (positive urine or blood pregnancy test (a pregnancy test must be obtainedwithin 7 days prior to randomization in people of childbearing potential))

9. Allergy or hypersensitivity to Recombinant Tissue Plasminogen Activator (rt-PA), oriodinated contrast, except for mild-moderate contrast allergies for which steroidpre-medication can be used

10. Life expectancy < 1 year

11. Chronic inability to independently walk prior to the current PE episode (e.g.wheelchair dependent, walker or cane dependent, paraplegic, and/or bed-bound)

12. Allergy to heparin or history of Heparin-Induced Thrombocytopenia (HIT)

13. Unable or unwilling to provide informed consent

14. Major contraindication or unsuitability for all CDT methods available at theClinical Center