It should be emphasized, that this clinical pathway in Bern is only possible due to the fact, that there is an experienced interdisciplinary and standardized approach to patients with pulmonary embolism. Pulmonary embolism response teams (PERT) are established in several academic hospitals in the United States of America, including the Brigham and Women's Hospital and the Massachusetts General Hospital, both in Boston, Harvard Medical School. The University Hospital Bern has established the first interdisciplinary PERT in Europe in 2010 and remains the only European academic hospital offering both surgical embolectomy and catheter therapy on a 24 basis to patients with acute pulmonary embolism at increased risk of death. The Cardiovascular Center of the University Hospital Bern belongs to one of the few hospitals worldwide that has clinical experience in both surgical embolectomy and catheter therapy. Excellent clinical results were published for both techniques. Therefore, the University Hospital Bern has the unique opportunity to perform a randomized controlled clinical trial and compare both techniques. A large multicenter trial powered for a mortality analysis would be ideal to investigate the efficacy and safety of both techniques. A clinical trial designed for non-inferiority would require more than 1000 patients enrolled from over 50 centers. However, due to the fact that PERTs are not yet established in Europe, we intend to perform a single center study in Bern using surrogate endpoints, i.e. reversal of right heart failure and reduction in thrombus load. The study will not be powered for clinical endpoints but will assess secondary endpoints, including mortality, bleeding complications, exercise performance, and quality of life up to 12 months after the revascularization procedure.