EXPERT REVIEW PERIPHERAL INTERVENTIONS 1721 EuroIntervention 2018;13: 1721-1727 published online November 2017 DOI: 10.4244/EIJ-D-17-00437 © Europa Digital & Publishing 2018. All rights reserved. *Corresponding author: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark. E-mail: jacobgschultz@clin.au Catheter-based therapies in acute pulmonary embolism Jacob Schultz 1 *, MD; Asger Andersen 1 , MD, PhD; Christopher Kabrhel 2,3 , MD, MPH; Jens Erik Nielsen-Kudsk 1 , MD, DMSc 1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 2. Center for Vascular Emergencies, Massachusetts General Hospital, Boston, MA, USA; 3. Harvard Medical School, Boston, MA, USA The complete list of references is published online at: http://www.pcronline.com/eurointervention/129th_issue/277 Abstract Aims: We aimed to provide a systematic review of catheter-based therapies in acute pulmonary embolism (PE). Methods and results: Studies published in peer-reviewed journals before February 2017 were included and categorised according to the mechanism of thrombus removal: fragmentation, rheolytic therapy, aspira- tion or catheter-directed thrombolysis. Strengths, challenges and the level of evidence of each device were evaluated. We found 16 different catheter-based therapies for acute PE, all but one being used off-label. The majority of procedures involve catheter-directed thrombolysis. Aspiration therapy shows promise, but limited data are available. Rheolytic therapy should be used with caution, if at all, due to the high number of associated complications. Conclusions: Catheter-based therapies show promise as a treatment for acute PE, though evidence is lack- ing. Further research into the efficacy and safety of devices is needed. KEYWORDS • aspiration device • balloon inflation • pulmonary embolism • thrombectomy SUBMITTED ON 31/05/2017 - REVISION RECEIVED ON 1 st 21/10/2017 / 2 nd 20/11/2017 - ACCEPTED ON 22/11/2017