To date the management of pulmonary thrombo-embolism is still largely limited to anticoagulation. Heparin and oral anticoagulation have been shown to be effective in reducing recurrence and death in venous thrombo-embolism. During the acute stage, systemic thrombolytic therapy has also been advocated for the rapid dissolution of the thrombus in patients with haemodynamic instability. We describe four patients with acute pulmonary thrombo-embolism who were managed with catheter-based thrombus manipulation with intrapulmonary thrombolysis. This management strategy should be considered in patients with pulmonary thrombo-embolism who continue to deteriorate despite conventional management with anticoagulation or systemic thrombolysis.