Interventional techniques for managing acute-phase pulmonary embolism (PE) are under investigation, but their efficacy compared with anticoagulant alone remains uncertain.

To assess the efficacy and safety of catheter-directed interventions (CDI) compared with standard anticoagulation management in patients with intermediate–high-risk pulmonary embolism.

We conducted a large-scale, retrospective, multicentre cohort study of patients hospitalized with intermediate–high-risk PE between 2017 and 2024 in three intensive care units (ICU) and two cardiac ICUs. Patients were stratified based on the use of CDI versus standard anticoagulation. Data on demographics, clinical characteristics and outcomes were collected and analysed.

Among 1637 patients admitted for PE, 549 met the inclusion criteria. Of these, 258 patients (47%) received CDI, including 213 (83%) undergoing catheter-directed thrombolysis and 45 (17%) underwent thromboaspiration. The primary composite outcome of in-hospital mortality or systemic thrombolysis was significantly lower in the CDI group versus the standard-treatment group (3.1% vs. 7.2%; P=0.031); multivariable analysis demonstrated a 65% risk reduction (adjusted odds ratio 0.35, 95% confidence interval 0.14–0.80). Minor bleeding events were more frequent with CDI whereas major bleeding complications were similar between groups. Echocardiographic evaluations showed no significant differences in the incidence of pulmonary hypertension, but demonstrated a significant reduction in early and late systolic pulmonary artery pressure in the CDI group.

CDI appears to provide potential benefits in the management of intermediate–high-risk PE, including a reduction in the composite outcome of in-hospital mortality or systemic thrombolysis.