An overview of interventional pulmonary embolism management in the United Kingdom in 2026.

Pulmonary embolism (PE) remains a leading cause of sudden cardiovascular death, with 30-day mortality ranging from ∼2% in low-risk cohorts to >25% in haemodynamically unstable cases. This narrative review synthesises the contemporary (2026) evidence base for interventional PE management in a UK context. We review the epidemiology of PE and the role of clinical scoring systems, and emerging imaging-biomarker approaches. The current UK treatment framework, based on international guidelines and the integration of the pulmonary embolism response team (PERT), is outlined. Evidence from recent randomised studies of ultrasound-assisted catheter-directed thrombolysis (ULTIMA, SEATTLE II, and OPTALYSE) and large-bore mechanical thrombectomy (FLARE, EXTRACT-PE, and PEERLESS) is critically appraised, with ongoing trials (HI-PEITHO, STRIKE-PE, and STORM-PE) and UK-specific data highlighted. Particular attention is given to procedural decision-making aimed at rapid right ventricular unloading, minimising bleeding risk, and optimising cost-effectiveness within the National Health Service. Structured follow-up is emphasised to enable early identification of chronic thromboembolic pulmonary hypertension (CTEPH) and post-PE syndrome, both underdiagnosed yet clinically significant sequelae. In 2026, the management of high-risk and select intermediate-high-risk PE is shifting towards catheter-based reperfusion delivered by radiologists embedded in multidisciplinary teams. Understanding the evolving evidence landscape, adhering to structured pathways, and performing systematic follow-up allow the effective translation of recent advances into meaningful reductions in mortality and improvements in patients' long-term quality of life. Simultaneously, there remains a need for robust UK-specific outcome and cost-effectiveness data to guide commissioning and ensure equitable access.