News in the treatment of acute pulmonary embolism four years after publication of the ESC guidelines

Despite major medical advances, acute pulmonary embolism remains the third most common cause of cardiovascular death in Europe. Selecting the optimal treatment procedure is a challenge, particularly in view of the growing range of new catheter-based therapy systems. In the risk-adapted therapy model recommended in the current guidelines of the European Society of Cardiology, the treatment strategy is based on the probability of early mortality or serious complications. The assessment of the hemodynamic effects of pulmonary embolism on vital parameters and right ventricular function as well as the measurement of cardiovascular biomarkers are crucial for adequate patient selection. For patients with high or intermediate-high risk, the treatment approach should be chosen by an interdisciplinary team of experts. Depending on the risk stratification, the locally available options for reperfusion (systemic thrombolysis, catheter-based systems, surgical embolectomy) or parenteral anticoagulation alone as well as circulatory support measures should be evaluated. In hemodynamical ly unstable patients after unsuccessful lysis or with a high bleeding risk and contraindications for systemic lysis, new interventional procedures can be used as an alternative. This article aims to provide an overview of the available treatment options, current practice and recommendations.