Emergency intervention in acute pulmonary thromboembolism category E report of a rescue case according to AHA 2026 guidelines

Introduction: Massive pulmonary embolism (PE) is a cardiovascular emergency with high morbidity and mortality. The new AHA 2026 guidelines emphasize early catheter-directed intervention to preserve right ventricular (RV) function.
Case Report: A 70-year-old female with a history of hypertension, obesity, and chronic kidney disease (CKD) presented with sudden dyspnea and syncope. Upon admission, she exhibited hypertensive crisis (230/130 mmHg) and tachycardia. Echocardiography revealed RV strain with a "D-sign," and CT angiography confirmed massive bilateral saddle PE. Management included mechanical aspiration thrombectomy followed by ultrasound-facilitated thrombolysis using the EKOS system (alteplase + heparin) for 24 hours. The patient showed immediate hemodynamic improvement and was discharged on the fourth day with oral anticoagulation.
Discussion: Hybrid management (mechanical and directed pharmacological) allows for rapid RV decompression and minimizes bleeding risk in CKD patients, overcoming the limitations of systemic thrombolysis.
Conclusions: Ultrasound-assisted catheter-directed therapy is safe and effective in high-risk PE, enabling accelerated recovery and preventing long-term sequelae.