Abstract: Pulmonary embolism (PE) is a common cardiovascular disease with significant mortality Some patients with high-risk PE are not eligible for current treatment options, such as thrombolysis or surgical embolectomy; moreover, some patients with intermediate-risk PE may benefit from a more aggressive approach rather than the sole anticoagulation therapy In these settings, catheter thrombectomy is an evolving technology and is becoming part of the treatment options for the management of major PE. We report our experience of percutaneous AngioJet Rheolytic Thrombectomy (ART) for the treatment of high and intermediate-risk PE in patients ineligible for current treatment options. Methods and results. Between September 2001 and October 2012 a total of 91 patients with major PE referred for ART to our catheterization laboratory were included. Twenty-eight patients presented with high-risk PE and 63 with intermediate-risk PE. Clinical data including medical history, procedural characteristics, in-hospital complications and survival were collected. Adjunctive local thrombolysis was performed in 15.4% of patients. Technical success was obtained in 94.5% of patients, with a significant reduction of Miller index (p<0.0001). Total in-hospital mortality occurred in 11 patients (12.1%), of whom 7 (63.6%) presented with high-risk PE. The rate of major bleeding complications was 7.7%. Laboratory experience was significantly associated to a lower rate of major bleedings (p=0.03). Conclusions. In experienced hands ART can be an effective and safe treatment option for major (i.e. high and intermediate-risk) PE in patients who may not be eligible for thrombolytic therapy or surgical embolectomy, or who may benefit from a more aggressive approach on top of anticoagulation therapy. References 1. Torbicki A., Perrier A., Konstantinides S. et al. Guidelines on the diagnosis and management of acute pulmonary embolism. 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