{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:08:08Z","timestamp":1779455288297,"version":"3.53.1"},"reference-count":25,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Ultrasound-assisted catheter-directed thrombolysis (USAT) and mechanical thrombectomy (MT) are increasingly used for intermediate-high-risk pulmonary embolism (PE), but real-world comparisons are scarce. We compare 30-day all-cause, cardiovascular, non-cardiovascular, PE-related, and major bleeding events between intermediate-high-risk patients with acute PE treated with USAT or MT. Methods: We analyzed 286 patients with acute intermediate-high-risk PE enrolled in the multicenter USAT IH-PE registry (March 2019\u2013October 2025). Patients underwent USAT (EKOS\u2122, Boston Scientific, Marlborough, MA, USA) or MT (FlowTriever, Inari Medical, Irvine, CA, USA or Indigo, Penumbra, Inc., Alameda, CA, USA) during index hospitalization. Primary endpoints were 30-day all-cause, cardiovascular, and PE-related mortality. Propensity score matching (1:1) balanced baseline characteristics. Kaplan\u2013Meier analyses with log-rank testing assessed time-to-event outcomes. Results: After matching (69 patients per group), baseline clinical and hemodynamic variables were well balanced. Both USAT and MT significantly improved RV\/LV ratio, tricuspid annular plane systolic excursion (TAPSE), and PASP (all p &lt; 0.001). Thirty-day all-cause mortality was similar between USAT and MT (13.0% vs. 11.5%; p = 0.78), with no differences in cardiovascular or PE-related mortality (8.6% vs. 1.4%, p = 0.58 and 5.7% vs. 1.4%, p = 0.17, respectively). Major bleeding was infrequent and observed only in the USAT group (4.3%). Conclusions: In this real-world multicenter cohort, USAT and MT showed comparable short-term mortality, safety, and echocardiographic recovery, supporting individualized catheter-based reperfusion strategies for intermediate-high-risk PE.<\/jats:p>","DOI":"10.3390\/jcm15114023","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:14:52Z","timestamp":1779452092000},"page":"4023","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Outcomes of Ultrasound-Assisted Thrombolysis and Mechanical Thrombectomy in Intermediate-High-Risk Pulmonary Embolism"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4904-1175","authenticated-orcid":false,"given":"Claudia","family":"Colombo","sequence":"first","affiliation":[{"name":"Cardiology 1, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Zuin","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Ferrara, 44100 Ferrara, Italy"},{"name":"Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35128 Padua, Italy"},{"name":"Department of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, South Padova Hospitals, 35043 Schiavonia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Russo","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0571-3918","authenticated-orcid":false,"given":"Mario","family":"Iannaccone","sequence":"additional","affiliation":[{"name":"Cardiology Unit, San Giovanni Bosco, ASL Citt\u00e0 di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Solcia","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3968-4759","authenticated-orcid":false,"given":"Francesco","family":"Musca","sequence":"additional","affiliation":[{"name":"Cardiology 4, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria Emanuela","family":"Bossi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1373-4348","authenticated-orcid":false,"given":"Andrea","family":"Cesari","sequence":"additional","affiliation":[{"name":"Cardiology 1, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Gualini","sequence":"additional","affiliation":[{"name":"Cardiology 1, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6555-4598","authenticated-orcid":false,"given":"Federica","family":"Fumarola","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, San Giovanni Bosco, ASL Citt\u00e0 di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5052-8215","authenticated-orcid":false,"given":"Alberto","family":"Balderi","sequence":"additional","affiliation":[{"name":"Unit of Interventional Radiology, Department of Radiology, A.O. S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8333-672X","authenticated-orcid":false,"given":"Francesca","family":"Giordana","sequence":"additional","affiliation":[{"name":"Division of Cardiology, A.O. S. Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8345-8663","authenticated-orcid":false,"given":"Andrea","family":"Discalzi","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Surgical Sciences, University of Torino, 12100 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0228-8290","authenticated-orcid":false,"given":"Lorenzo","family":"Tua","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, 20142 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8319-0935","authenticated-orcid":false,"given":"Stefano","family":"Buratti","sequence":"additional","affiliation":[{"name":"Cardiology Division, ASST Santi Paolo and Carlo, San Paolo Hospital, 20142 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruggero","family":"Vercelli","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, ASST Santi Paolo Carlo, 20142 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Cianfanelli","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Adamo","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaide","family":"Chieffo","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Bocuzzi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, San Giovanni Bosco, ASL Citt\u00e0 di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9732-9459","authenticated-orcid":false,"given":"Matteo","family":"Montorfano","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"},{"name":"School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9459-2488","authenticated-orcid":false,"given":"Fabrizio","family":"Oliva","sequence":"additional","affiliation":[{"name":"Cardiology 1, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8150-474X","authenticated-orcid":false,"given":"Alice","family":"Sacco","sequence":"additional","affiliation":[{"name":"Cardiology 1, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. 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