To compare in hospital clinical outcomes and one month follow up of systemic thrombolysis versus catheter directed management for the treatment of acute intermediate- high risk pulmonary embolism (using streptokinase or tissue plasminogen activator (TPA) and catheter-based intervention group using Penumbra System).

Inclusion Criteria:

Patients diagnosed with acute intermediate-high pulmonary embolism

Exclusion Criteria:

• Patients less than 18 years of age.
• Low risk, intermediate low risk, acute pulmonary embolism
• patients with RV masses will be excluded.
• Patient refusal of treatment strategy.

All patients will be subjected to:

On admission:

Detailed history for assessment of risk factors

Clinical examination:

Laboratory investigations.

Trans-thoracic echocardiography to detect signs of PE:

MSCT pulmonary angiography: for assessment of site, size and shape of pulmonary embolism.

PESI and sPESI scores will be calculated for all patients.

In hospital follow up:

During hospital stay all patients will be followed up daily for assessment of hemodynamic, oxygen saturation, TTE, troponin level, need of mechanical ventilation or death.

One month follow up after discharge: for the assessment of:

Hemodynamic. Transthoracic echocardiography. MSCT pulmonary angiography.

compare in hospital clinical outcomes and one month follow up of systemic thrombolysis versus catheter directed management for the treatment of acute intermediate- high risk pulmonary embolism (using streptokinase or tissue plasminogen activator (TPA) and catheter-based intervention group using Penumbra System).