<p>Acute pulmonary embolism is a&#xa0;life-threatening condition. According to the current guidelines pulmonary embolisms are treated in a&#xa0;stepwise approach depending on the severity (high, intermediate high, intermediate low and low) of the pulmonary embolism. High-risk patients are currently given lysis therapy, provided there are no contraindications, while patients with intermediate high and intermediate low risk are only given lysis therapy if the clinical condition or hemodynamics worsen; however, the data basis for lysis therapy has historically grown and is both incoherent and inconsistent. Furthermore, large randomized trials are lacking. As long as the systemic lysis therapy can be performed in the absence of contraindications, the patients in meta-analyses show that lysis therapy halves the mortality compared with anticoagulation therapy alone but also triples the risk of major and fatal bleeding. In the past 4 years the treatment of pulmonary embolism has fundamentally changed due to the advent of dedicated aspiration systems and positive clinical study results, which the current guidelines do not yet reflect. There are currently two CE approved aspiration thrombectomy systems available. The Inari FlowTriever system and the Penumbra Indigo Lightning system. Inari uses large-bore, manual aspiration catheters up to 24&#xa0;French, while Penumbra uses 12F or 16F&#xa0;catheters with continuous aspiration and an algorithm-controlled electric pump. Aspiration thrombectomy enables the direct percutaneous removal of thrombotic material from the pulmonary arteries via a&#xa0;femoral venous access. Studies and registries so far show that aspiration thrombectomy is safe and results in rapid hemodynamic and clinical improvement; however, the results of larger randomized trials are currently pending.</p>