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Hani Al-Terki, Andreas Mügge, Michael Gotzmann, Vedat Tiyerili, Friederike Klein, Marcus Franz, Sven Möbius-Winkler, Abdelrahman Elhakim

• Ultrasound-accelerated thrombolysis (USAT) is an advanced interventional therapy for patients with intermediate–high-risk pulmonary embolism (PE) who deteriorated on anticoagulation or for high-risk patients for whom systemic thrombolysis is contraindicated. The aim of this study is to investigate the safety and efficacy of this therapy with a focus on the improvement of vital signs and laboratory parameters. Seventy-nine patients with intermediate–high-risk PE were treated with USAT from August 2020 to November 2022. The therapy significantly decreased the mean RV/LV ratio from 1.2 \(\pm\) 0.22 to 0.9 \(\pm\) 0.2 (\(\it p\) < 0.001) as well as the mean PAPs from 48.6 \(\pm\) 11 to 30.1 \(\pm\) 9.0 mmHg (\(\it p\) < 0.001). The respiratory and heart rate decreased significantly (\(\it p\) < 0.001). Serum creatinine decreased significantly from 1.0 \(\pm\) 0.35 to 0.9 \(\pm\) 0.3 (\(\it p\) < 0.001). There were 12 access-associated complications, which could be treated conservatively. One patient had haemothorax after the therapy and had to be operated on. USAT is an effective therapy for patients with intermediate–high-risk PE, with favourable hemodynamic, clinical, and laboratory outcomes.