Diseases of the aorta, pulmonary and peripheral vessels: Edited by Alan BravermanTherapy for acute high-risk pulmonary embolism: thrombolytic therapy and embolectomyMeneveau, Nicolas Author Information Cardiology Department, University Hospital Jean Minjoz, Besancon, France Correspondence to Nicolas Meneveau, MD, PhD, Cardiology Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000 Besancon, France Tel: +33 381 668 187; fax: +33 381 668 582; e-mail: [email protected] Current Opinion in Cardiology: November 2010 - Volume 25 - Issue 6 - p 560-567 doi: 10.1097/HCO.0b013e32833f02c5 Buy Metrics Abstract Purpose of review Acute pulmonary embolism remains associated with high morbidity and mortality rates despite currently available therapeutic options. This review outlines the most recent changes in this field and summarizes the main indications for thrombolytic therapy and surgical or catheter-based embolectomy in patients with high-risk pulmonary embolism. Recent findings There have been no major advances in therapy for high-risk pulmonary embolism over the past few years. The main change concerns risk stratification, which now classifies patients as high risk versus intermediate or low risk, replacing the former terminology of acute massive, submassive or nonmassive pulmonary embolism. Risk stratification is now oriented toward evaluation of the risk of early pulmonary embolism-related death. Thrombolysis is the mainstay of therapy in high-risk pulmonary embolism. Surgical embolectomy has become more frequent, due to the reduction in mortality risk associated with this technique. However, it remains limited to patients unsuitable for thrombolysis. Catheter-based embolectomy is reserved for situations in which neither thrombolysis nor surgical embolectomy is possible. Summary Thrombolytic treatment should be first-line therapy in patients with high-risk pulmonary embolism presenting with cardiogenic shock and/or persistent arterial hypotension, with very few absolute contraindications. Both surgical and catheter pulmonary embolectomy are valuable therapeutic options in patients in whom thrombolysis is absolutely contraindicated or has failed. © 2010 Lippincott Williams & Wilkins, Inc.