According to current guidelines of the European Society of Cardiology (ESC) published in 20146 catheter-directed treatment (Grade 2aC) or surgical embolectomy (Grade 1C) should be considered in all patients with PE at high risk, in whom systemic thrombolytic therapy is contraindicated or has failed. Also, catheter-directed treatment (Grade 2bB) or surgical embolectomy (Grade 2bC) may be considered in intermediate-high-risk patients with PE. However, it remains unclear, which reperfusion strategy is most appropriate for high and intermediate-high-risk patients with PE.