“Sometimes you feel like a nut. Sometimes you don't.” As Joey Levine sang for the Peter Paul Candy Company in 1970, different situations call for different options. Acute pulmonary embolism (PE), the third most common cause of cardiovascular death in the United States [ ], is categorized into 3 clinical situations based upon the presence or absence of hemodynamic instability and right ventricular (RV) strain (e.g., RV dysfunction, abnormal cardiac biomarkers) ( Table 1 ). Treatment options for PE include systemic anticoagulation (SA), thrombolysis (systemic or catheter-directed [standard or ultrasound assisted]), and embolectomy (catheter-based or surgical). While the management strategies for low-risk and massive (high-risk) PE are clear based on substantial evidence, the optimal treatment strategy for submassive (intermediate-risk) PE remains controversial.