Inclusion Criteria:  Age >18 years old. Both gender males and females. Patients with angiographically confirmed acute high risk pulmonary embolism with shock index >1. pulmonary arterial occlusion with >50% involvement of the central (main and/or lobar) pulmonary, and dysfunction of the right ventricle and elevated troponin. patients with high risk pulmonary embolism who remain unstable after receiving fibrinolysis patients with high risk PE pulmonary embolism who cannot receive fibrinolysis patients with intermediate high risk PE pulmonary embolism with adverse prognosis (new hemodynamic instability, worsening respiratory failure, severe RV (right ventricle) dysfunction, or major myocardial necrosis)  Exclusion Criteria:  patients with echocardiographically confirmed right sided thrombi. patients with low-risk PE pulmonary embolism or submassive acute PE pulmonary embolism with minor RV (right ventricle) dysfunction, minor myocardial necrosis, and no clinical worsening Anaphylactic reaction to contrast media. Acute renal failure or severe chronic non-dialysis dependent kidney disease. Uncooperative patient