Purpose <p>To compare the efficacy of the 8F Zelante and 6F Solent Angiojet thrombectomy catheters in the treatment of acute pulmonary embolism (PE).</p> Methods <p>A retrospective multicenter study was conducted, collecting data from patients with acute PE between January 2019 and December 2024. A total of 98 cases were included based on inclusion and exclusion criteria. Patients were divided into two groups based on the Angiojet catheter used: the 8F group and the 6F group, and then matched at a 1:1 ratio. The primary outcomes comprised 7-day all-cause mortality, the need for bailout thrombolysis, and perioperative changes in ancillary and laboratory parameters. The secondary outcome comprised treatment-related complications, including arrhythmias, hypotension, hemoptysis, aggravation of chest tightness, severe acute renal insufficiency, and hemoglobinuria.</p> Results <p>Twenty-seven patients were included in each group. The 7-day all-cause mortality did not differ significantly between the 8F and 6F group [(2/27) vs. (3/27), <i>P</i> = 1.000]. The need for bailout thrombolysis was significantly higher in the 6F group [(17/27) vs. (8/27), <i>P</i> = 0.028]. A statistically significant intergroup difference was found in the reduction of Miller index and mean pulmonary artery pressure (MPAP) during the perioperative period. The incidence of transient arrhythmias was significantly higher in the 8F group [(21/27) vs. (11/27), <i>P</i> = 0.012]. The incidence of other complications did not differ between groups.</p> Conclusion <p>Compared to the 6F Solent catheter, the 8F Zelante catheter demonstrated superior thrombectomy efficacy in PE, reducing the need for bailout thrombolysis—a potential benefit for patients with contraindications to thrombolysis. This advantage, however, was accompanied by a higher incidence of transient arrhythmias.</p> Graphical Abstract <p></p>