[Italian Society of Interventional Cardiology (SICI-GISE) Position paper: Integrated management and transcatheter interventions for acute pulmonary embolism]

Pulmonary embolism (PE) is commonly treated primarily with pharmacological therapy, while advanced reperfusion therapies (transcatheter or surgical) are considered only in cases of contraindications or failure of standard therapies. Treatment algorithms vary depending on the patient's risk, with patients at intermediate or high risk potentially requiring evaluation for such advanced reperfusion therapies. Critical scenarios, such as contraindications to systemic thrombolysis or failure of pharmacological protocols, necessitate the activation of a multidisciplinary pulmonary embolism response team (PERT) and prompt therapeutic escalation. Integrated in-hospital pathways and the extension of PERT at the provincial/regional level are recommended to improve access to advanced therapies and promote uniform management of PE. Larger randomized clinical trials are needed to assess the efficacy of transcatheter therapies compared to current standards. In conclusion, a multidisciplinary and standardized approach, supported by evidence-based guidelines, is essential to optimize PE management and improve clinical outcomes. The Italian Society of Interventional Cardiology (SICI-GISE) aims to promote such standardization nationally with this expert position paper, ensuring appropriateness and equity of care for patients, as well as fostering further scientific research and education.