Patients with massive and submassive pulmonary embolism (PE) have an increased risk of cardiovascular collapse and death.1 Standard anticoagulation alone is inadequate for patients with massive (high-risk) PE.2 Early reperfusion therapy with fibrinolysis, surgical embolectomy, or catheter-based ‘pharmacomechanical’ therapy is recommended.3–5 For patients with submassive (intermediate-risk) PE, routine reperfusion is not advised. However, a subset of submassive PE patients who have increased cardiac troponin and imaging evidence of right heart dysfunction may benefit from reperfusion.5,6 While the data are most extensive for systemic fibrinolysis,6–8 clinicians are often hesitant to administer fibrinolytic therapy, even in the highest-risk PE patients, because of the concern of major bleeding, especially intracranial hemorrhage (ICH).