Is there an optimal “door to cath time” in the treatment of acute pulmonary embolism with catheter-directed thrombolysis?

Pulmonary embolism (PE) is the third leading cause of cardiovascular death, after heart attack and stroke (1). The management of PE varies depending on the stratification of low, intermediate or high-risk (2). High-risk or “massive” PE is characterized by hemodynamic instability. Intermediate risk or “submassive” PE is hemodynamically stable, however, there is evidence of right ventricular (RV) dysfunction determined by imaging or elevated cardiac biomarkers. Finally, low-risk PE is neither hemodynamically unstable nor is there evidence of RV dysfunction (3). Patients presenting with high-risk PE have in-hospital mortality rates up to 52%, whereas intermediate-risk and low-risk PE mortality rates of up to 15% and less than 5%, respectively (4)